Protecting Nursing Home Workers: OSHA’s Safety and Health Program Approach

Protecting Nursing Home Workers: OSHA’s Safety and Health Program Approach

اسلاید 1: Protecting Nursing Home Workers: OSHA’s Safety and Health Program Approach

اسلاید 2: BackgroundThe nursing home industry is one of America’s fastest growing industries.Approximately 1.6 million workers are employed at 21,000 work sites.By the year 2005, industry employment will rise to an estimated 2.4 million workers.

اسلاید 3: Bureau of Labor Statistics (BLS) DataIn 1994, nursing and personal care facilities reported over 221,000 nonfatal occupational injuries and illnesses to BLS.Among U.S. industries with 100,000 or more nonfatal injury or illness cases, nursing homes have the third highest rate -- 16.8 injuries and illnesses per 100 full-time workers.

اسلاید 4: Major Sources of Injuries and Illnesses - BLS DataResident handlingFallsContact with objects and equipmentAssaults and violent acts by personsExposure to harmful substances

اسلاید 5: Nursing Home Jobs with the Most Injuries The BLS data showed that nursing aides, orderlies, and attendants accounted for 70% of nursing home injuries that resulted in days away from work. Women employees had more injuries that resulted in lost workdays than did men employees.

اسلاید 6: Injury and Illness TopologySource: 1994 BLS Survey of Occupational Injuries & Illnesses

اسلاید 7: What Nursing Home Jobs Have the Most Injuries/Illnesses with Days Away from Work?Source: 1994 BLS Survey of Occupational Injuries & Illnesses Total number of injuries/illnesses resulting in days away from work = 83,450

اسلاید 8: Number of Injuries/Illnesses* by Type of Event, Nursing and Personal Care Facilities, 1994Source: 1994 BLS Survey of Occupational Injuries & Illnesses, unpublished table.

اسلاید 9: Source of Injury or Illness Event*, Nursing and Personal Care Facilities, 1994Source: 1994 BLS Survey of Occupational Injuries & Illnesses, unpublished table.

اسلاید 10: Event or Exposure Causing Injury or Illness Involving Days Away from Work, 1994

اسلاید 11: Creating a Safety Culture

اسلاید 12: Safety Pays Off in Nursing HomesWorking safely helps protect employeesWorking safely affects the “bottom line”

اسلاید 13: OSHA’s Purpose . . . to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources . . .

اسلاید 14: All About OSHACoverageStandardsDevelopmentPermanentTemporary5(a)(1)Variances

اسلاید 15: Workplace InspectionsEvery covered establishment may be inspectedNo advance noticeEmployer may require warrantPrioritiesImminent dangerCatastrophes/Fatal accidentsEmployee complaints (may be handled by phone/fax)Programmed inspectionsFollowup inspections

اسلاید 16: Investigation of Complaints (Phone/Fax)Employer notified by phone of complaint allegationsFollowup in writing faxed (or mailed) to employerEmployer investigates and responds to OSHAComplaint advised of employer’s responseComplaint closed with satisfactory response

اسلاید 17: Inspection ProcessInspector’s credentialsOpening conferenceInspection tourClosing conferenceCitations/penalties

اسلاید 18: Appeals ProcessEmployerInformal conferencePMANotice of ContestReview by OSHRCAppeals in State Plan statesEmployeeContest of abatement periodRequest for informal review (if complaint) or informal conference

اسلاید 19: Responsibilities and RightsEmployerEmployeehttp://www.osha.gov/Publications/osha3000.htmlhttp://www.osha.gov/Publications/3021.html

اسلاید 20: Recordingkeeping Recording Criteria Decision Tree

اسلاید 21: Revisions to Bloodborne StandardAdditional definitions, paragraph (b)New requirements in the Exposure Control Plan, paragraph (c)Solicitation of input from non-managerial employees, paragraph (c)Sharps injury log, paragraph (h)See details of changes in: http://www.osha.gov/SLTC/bloodbornepathogens/standards.html

اسلاید 22: Resident RightsOlder Americans ActEstablishes Nursing Home Ombudsman Program in each stateResponsibilitiesMonitor performance of agencies dealing with nursing homesReceive/monitor complaints by or on behalf of individual residentsCoordinate volunteer programsCarry out public educational programsComment on state/local policies

اسلاید 23: Resident RightsNursing Home Reform Law of 1987Applies to facilities participating in Medicare and/or Medicaid programsFocuses on individuals: entitled to receive all care and services to attain and maintain highest possible functioning in 13 specified areasEstablishes “quality of life” requirements for homelike environment and resident choices

اسلاید 24: Resident RightsNursing Home Reform Law (cont’d)Establishes resident rightsFinancial - control own moneyPrivacyMeeting with friends and familyNon-discrimination based on payment methodProtections against transferring in or our of facilities

اسلاید 25: Resident RightsNursing Home Reform Law (cont’d)Establishes uniform assessment for medications, activities of daily living, and customary routines: resident choices about bedtimes, bath times, other routines from before they entered the facilityBasis of individualized care planEstablishes standards for nursing aid training and competence

اسلاید 26: Elements of a Safety and Health ProgramManagement Leadership and Employee ParticipationWorkplace AnalysisAccident and Record AnalysisHazard Prevention and ControlEmergency ResponseSafety and Health Training

اسلاید 27: Management Leadership and Employee ParticipationManagement LeadershipEmployee ParticipationImplementation ToolsContractor Safety

اسلاید 28: Management Leadership Visible management leadership provides the motivating force for an effective safety and health program.

اسلاید 29: Employee Participation Employee participation provides the means through which workers identify hazards, recommend and monitor abatement, and otherwise participate in their own protection.

اسلاید 30: Implementation Tools Implementation tools, provided by management, include:budgetinformationpersonnelassigned responsibilityadequate expertise and authoritymeans to hold responsible persons accountable (line accountability)program review procedures

اسلاید 31: Contractor Safety An effective safety and health program protects all personnel on the worksite, including contractors. It is the responsibility of management to address contractor safety.

اسلاید 32: Workplace AnalysisSurvey and Hazard AnalysisInspectionHazard Reporting

اسلاید 33: Survey and Hazard Analysis An effective, proactive safety and health program will seek to identify and analyze all hazards. In large or complex workplaces, components of such analysis are the comprehensive and analysis of job hazards and changes in conditions.

اسلاید 34: Inspection To identify new or previously missed hazards and failures in hazard controls, an effective safety and health program will include regular site inspections.

اسلاید 35: Hazard Reporting A reliable hazard reporting system enables employees, without fear of reprisal, to notify management of conditions that appear hazardous and to receive timely and appropriate responses.

اسلاید 36: Accident and Record AnalysisAccident InvestigationData Analysis

اسلاید 37: Accident Investigation An effective program will provide for investigation of accidents and “near miss” incidents, so that their causes, and the means for their prevention, are identified.

اسلاید 38: Data Analysis An effective program will analyze injury and illness records for indications of sources and locations of hazards, and jobs that experience higher numbers of injuries. By analyzing injury and illness trends over time, patterns with common causes can be identified and prevented.

اسلاید 39: Hazard Prevention and ControlHazard ControlMaintenanceMedical Program

اسلاید 40: Hazard Control Workforce exposure to all current and potential hazards should be prevented or controlled by using engineering controls, wherever feasible and appropriate, work practices and administrative controls, and personal protective equipment.

اسلاید 41: Maintenance An effective safety and health program will provide for facility and equipment maintenance, so that hazardous breakdowns are prevented.

اسلاید 42: Medical Program An effective safety and health program will include a suitable medical program where it is appropriate for the size and nature of the workplace and its hazards.

اسلاید 43: Emergency Response Emergency preparedness - There should be appropriate planning, training/drills, and equipment for response to emergencies. First aid/emergency care should be readily available to minimize harm if an injury or illness occurs.

اسلاید 44: Safety and Health Training Safety and health training should cover the safety and health responsibilities of all personnel who work at the site of affect its operations. It is most effective when incorporated into other training about performance requirements and job practices. It should include all subjects and areas necessary to address the hazards at the site.

اسلاید 45: Safety and Health Hazards in Nursing HomesBloodborne PathogensTuberculosisWorkplace ViolenceOther Hazards

اسلاید 46: Bloodborne Pathogens Pathogenic organisms that are present in human blood and can cause disease in humans. These include, but are limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

اسلاید 47: 29 CFR 1910.1030 Bloodborne Pathogens StandardScope and ApplicationDefinitionsExposure Control PlanMethods of ComplianceHIV and HBV Research Laboratories and Production FacilitiesHepatitis B Vaccination and Post-Exposure Follow-upCommunication of Hazards to EmployeesRecordkeepingEffective Dates

اسلاید 48: Highlights of 29 CFR 1910.1030 The standard applies to all employees with occupational exposure to blood and other potentially infectious materials.

اسلاید 49: Highlights of 29 CFR 1910.1030 (Cont’d)Exposure Control Plan includes:The written exposure determination;The procedures for evaluating the circumstances surrounding an exposure incident; andThe schedule and method of implementing other sections of the standard.

اسلاید 50: Highlights of 29 CFR 1910.1030 (Cont’d)Methods of ComplianceUniversal PrecautionsEngineering and Work Practice ControlsPersonal Protective EquipmentHousekeeping

اسلاید 51: Highlights of 29 CFR 1910.1030 (Cont’d)Hepatitis B VaccinationHBV vaccination must be made available within 10 working days of initial assignment to all employees who have occupational exposure.HBV vaccination must be made available without cost to the employee, at a reasonable time and place, and by a licensed health care professional.

اسلاید 52: Highlights of 29 CFR 1910.1030 (Cont’d) Post-exposure Evaluation and Follow-up The employer must make a confidential medical evaluation and follow-up to employees following an exposure incident.

اسلاید 53: Highlights of 29 CFR 1910.1030 (Cont’d) Communication of Hazards to EmployeesLabels and signsInformation and training

اسلاید 54: Highlights of 29 CFR 1910.1030 (Cont’d) RecordkeepingMedical RecordsTraining Records

اسلاید 55: Tuberculosis (TB)Infectious disease caused by the bacterium, Mycobacterium tuberculosisSpread by airborne droplets generated when a person with TB disease coughs, sneezes, speaks, or singsInfection occurs when a susceptible person inhales droplet nuclei containing the bacteria which become established in the bodyMantoux tuberculin skin test detects TB infection, positive results indicate infection. Other tests needed to confirm TB disease

اسلاید 56: TB OccurrenceSince 1985, the incidence of TB in the general U.S. population has increased 14% reversing a 30 year downward trend.However, during 1994 and 1995, there has been a decrease in TB cases in the U.S. likely due to increased awareness and efforts in prevention and control of TB.Cases of multi-drug resistant TB have recently been reported in 40 states.Worldwide, 8 million new TB cases and 3 million deaths occur annually.

اسلاید 57: Why Is TB Increasing?Multiple contributing factors:HomelessnessIntravenous drug useOvercrowding in institutional settingsHIV infectionReduced resources for TB control and treatmentImmigration from high TB prevalence areas

اسلاید 58: Tuberculosis - OSHA Enforcement On 2/9/96, OSHA issued agency-wide CPL 02-00-106, “Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis.” This enforcement directive cancels the enforcement guidelines issued on 10/8/93.

اسلاید 59: Tuberculosis - OSHA Enforcement (Cont’d)OSHA’s CPL 02-00-106 is based on the Centers for Control and Prevention (CDC) “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities” issued on 10/18/94. OSHA believes these guidelines reflect an industry recognition of the hazard as well as appropriate, widely accepted standards of practice to be followed by employers in carrying out their responsibilities under the OSH Act.

اسلاید 60: Workplace Identified by CDC with High Incidences of TBHealth Care SettingsCorrectional InstitutionsHomeless SheltersLong-term Care Facilities for the ElderlyDrug Treatment Centers

اسلاید 61: Highlights of CDC Guidelines and OSHA RequirementsDetermine the risk of exposureEarly diagnosis, isolation, treatmentRequirements for isolationTraining of workersSkin testingRespirators - OSHA standard 1910.134Other applicable standards - recordkeeping, employee access to records, accident prevention signs

اسلاید 62: Workplace Violence Any physical assault, threatening behavior, or verbal abuse occurring in the workplace. The workplace may be any location either permanent or temporary where an employee performs any work-related duty.

اسلاید 63: Acts of Aggression Which May Indicate RiskDisorderly conductVerbal threats to inflict bodily harmFascination with guns or other weaponsObscene phone callsIntimidating presenceHarassment of any nature

اسلاید 64: Types of Workplace Violence Incidents Based upon the relationship between the assailant/worker/workplace, violent incidents can be divided into categories:violence by strangersviolence by customers/clients/patientsviolence by co-workersviolence by personal relationship

اسلاید 65: Types of Workplace Violence Incidents (Cont’d)HomicidesLeading cause of job-related deaths for women, second leading cause for menClaimed the lives of 1,071 lives in 1994 (BLS data)Approximately 3 workers died each day under violent circumstances in 1994Nonfatal AssaultsBetween 1987-1992, one million persons were annually assaulted at work

اسلاید 66: Establishments Affected by Workplace Violence According to the Bureau of Labor Statistics, the highest number of homicides occur in night retail establishments. The highest number of nonfatal assaults occur in the health care and social service sectors.

اسلاید 67: Health Care Establishments Nonfatal assaults were primarily by patients/residents on nursing staff in health care institutions. According to one study (Goodman et al., 1994), between 1980-1990, 106 violence related deaths occurred among health care workers.

اسلاید 68: Nursing HomesBLS 1994 data showed more than 4900 assaults and violent acts against employees in nursing homes.Nursing aides and orderlies accounted for more than 50% of the assault victims.Most of the violent acts involved hitting, kicking, and beatings.

اسلاید 69: Examples of Why Health Care Workers are at Risk Of Work-Related AssaultsLow level staffing level during times of increased activity;Isolated work with patients/residents during examinations or treatment; and Lack of training of staff in recognizing and managing escalating hostile and assaulting behavior.

اسلاید 70: OSHA Guidelines - Overview Because of the high incidence of workplace violence, OSHA developed in 1996 a set of voluntary guidelines to prevent workplace violence. The guidelines cover a broad spectrum of workers (nearly 8 million) in psychiatric facilities, hospital emergency departments, drug treatment centers, community care and mental health facilities, pharmacies and long-term care facilities.

اسلاید 71: Violence Prevention Program ElementsManagement Commitment and Employee InvolvementWorksite AnalysisHazard Preventing and ControlTraining and EducationRecordkeeping and Evaluation of Program

اسلاید 72: AppendicesSHARP Staff Assault StudyWorkplace Violence ChecklistAssaulted and/or Battered Employee PolicyViolence Incident Report FormsSources of OSHA AssistanceSuggested Readings

اسلاید 73: Availability of Guidelines The OSHA “Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers” are available on the Internet at:http://www.osha.gov

اسلاید 74: General Duty Clause Section 5(a)(1) of the OSH Act requires that “Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

اسلاید 75: General Duty Clause (Cont’d) The general duty clause is used only where there is no OSHA standard that applies to the particular hazard involved. Examples of workplace hazards to which the general duty clause may apply include occupational exposure to TB and workplace violence.

اسلاید 76: General Duty Clause (Cont’d)Four elements are required for issuing general duty clause violations:The employer failed to keep the workplace free of a hazard to which employees of that employer were exposedThe hazard was recognizedThe hazard was causing or was likely to cause death or serious physical harmThere was a feasible and useful method to correct the hazard