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W‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ritten Assignment Occupational Safety and Health Administration (OSHA) In a few paragraphs, summarize the key functions of the Occupational Safety and Health Administration and what specific standards apply to nursing homes? How does your nursing home comply with the Bloodborne Pathogens Standards? When are employees trained? What methods are used to train staff? What steps are in place when a staff person receives a needle stick? What measures are in place to prevent needle sticks? How does your facility manage the care of HIV/AIDS or Hepatitis C positive residents? Do staff have the right to know about the positive infection status of the resident? Are there special precautions put in place? What is Personal Protective Equipment (PPE)? Where is it stored? Whose responsibility is it to provide employees with PPE? How does your nursing home promote hand hygiene/handwashing among employees, residents, and visitors? List and discuss at least 3 different OSHA Workplace Safety Standards. Identify a case scenario of a workplace safety incident in your nursing home. Discuss the case and management’s reponse to the incident. What is the responsibility of management to ensure a safe workplace? Describe an incident involving potential injury related to electricity, hydraulics, gas, or other power sources. Who in your building is authorized to use the lock out/tag out process? Was it used effectively? After review of your nursing home’s OSHA Hazard Communication Program and Lock Out/Tag Out Program, discuss the methods used to train your staff in these two standards? How often is the training conducted? Are there any ways you can improve your staff training? Outcomes Define the regulatory oversight of the Occupational Health and Safety Administration (OSHA) as it relates to nursing homes. Assess the requirements for nursing homes to comply with the Blood-borne Pathogens Standard. Delineate contributing factors leading to HIV?AIDS in nursing home residents. Define three different OSHA standards and guidance that impact workplace safety in the nursing home. Explain how the Lock Out/Tag Out Standard is applied in long-term care settings. Assess the Hazardous Communication Program in a long-term care setting. Allen Text: Pages 364-385, F441 Review the OSHA Website – Bloodborne Pathogens Standard Read the CMS Survey and Certification Advisory Letter: Point of Care Devices and Infection Control Read the CMS Survey and Certification Advisory Letter: Laundry and Infection Control Visit OSHA and read about the Bloodborne Pathogens Standard, Workplace Violence, Lockout/Tagout, Hazardous Communications, and the Nursing Home Ergonomics Guidance. Locate your nursing home’s OSHA Hazard Communication Program (HCP) and your nursing home’s OSHA Lock Out/Tag Out Policy Lecture Notes In this lesson, we will learn about the Occupational Safety and Health Administration (OSHA) and examine OSHA laws, standards, and guidance that impact health care providers. OSHA was created in 1971, and its mission is to ensure safe and healthy workplaces in America. Since 1971, workplace fatalities have been dramatically cut, and there has been a 40 percent decline in the rate of occupational injury and illness (Townsend and Davis, 2011). According to the 2009 CMS statistics, there are approximately 15,900 nursing homes in the . with million residents living in them (CMS, 2010). There are approximately 2 million employees in these nursing homes with about million direct care nursing staff (AHCA/NCAL, 2010). Workplace safety issues in nursing homes involve employee activities which may take place in resident rooms and throughout the building and grounds. Specific examples of hazards include patient handling/ lifting, workplace violence, infectious disease control, the use of chemicals and substances, and the use of machinery and devices. In 2010, nursing homes and personal care facilities had one of the highest rates of injury and illness among the industries for which lost workday injury and illness (LWDII) rates are calculated. According to the Bureau of Labor Statistics, nursing and personal care facilities experienced an average lost days of work (LDW) rate of compared with a rate of for private industry as a whole. Health care workers face a number of serious safety and health hazards. They include bloodborne pathogens and biological hazards, potential chemical and drug exposures, ergonomic hazards from lifting and repetitive tasks, and workplace violence. OSHA has numerous standards and guidance. Nursing homes and personal care facilities must comply with all the General Industry standards (29 CFR 1910). Of these, the following standards were the most frequently cited by federal OSHA from October 2011 through September 2012 in nursing and personal care facilities. 17 , Bloodborne pathogens Appendix A, Hepatitis B vaccine declination , Hazard communication Appendix A, Health hazard criteria , Maintenance, safeguards, and operational features for exit routes , Wiring methods, components, and equipment for general use , Annual summary (other OSHA injury and illness recordkeeping requirements) , The control of hazardous energy (lockout/tagout) The focus of this lesson is on OSHA’s Bloodborne Pathogens standard, which is a large and encompassing standard for nursing homes to comply with. OSHA’s Bloodborne Pathogen standard took effect in March 1992. This standard was designed to prevent more than 200 deaths and 9,000 bloodborne infections every year. While the standard was primarily aimed at hospitals, funeral homes, nursing homes, clinics, law enforcement agencies, emergency responders, and HIV/HBV research laboratories, it impacts anyone who can “reasonably expect to come in contact with blood or potentially infectious materials” as part of their job and is covered by the standard. Bloodborne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS. Workers exposed to bloodborne pathogens are at risk for serious or life-threatening illnesses. Employees must be educated in OSHA’s Bloodborne Pathogens Rules for Healthcare Facilities, including universal precautions. Bloodborne pathogens may be present in saliva, tears, spinal fluid, vaginal secretions, semen, and breast milk (OSHA, 2013). Compliance with the OSHA standard on Occupational Exposure to Bloodborne Pathogens begins with an Exposure Control Plan (ECP). The ECP is a key document to assist organizations in implementing and ensuring compliance with the standard, thereby protecting employees. An ECP should include the following: Determination of employee exposure Implementation of various methods of exposure control, including the following: Universal precautions Engineering and work practice controls Personal protective equipment (PPE) Housekeeping/ Laundry Hepatitis B vaccination Post-exposure evaluation and follow-up Communication of hazards to employees and training Recordkeeping Procedures for evaluating circumstances surrounding exposure incidents Safe needle devices/needlestick prevention Implementation methods for these elements of the standard and examples of an ECP can be found at . In the long-term care setting, employees may exhibit different attitudes toward residents with the Hepatitis C, HIV virus, or other infectious diseases. The United States has come a long way from the stigma that surrounded HIV/AIDS in the early 1980’s, but discrimination and misinformation are still prevalent in some nursing homes and health care settings. When people think of those populations most impacted by HIV/AIDS, older persons are often the last to come to mind. However, older people are at increasing risk for HIV/AIDS and other STDs. A growing number of older people now have HIV/AIDS. People age 50 and older represent almost one-fourth of all people with HIV/AIDS in the . Because older people often don’t get tested for HIV/AIDS on a regular basis, there may be even more cases than currently known. Many factors contribute to the increasing risk of infection in older people. In general, older Americans know less about HIV/AIDS and STDs than younger age groups because the elderly have been neglected by those responsible for education and prevention messages. In addition, older people are less likely than younger people to talk about their sex lives or drug use with their doctors, and doctors don’t tend to ask their older patients about sex or drug use. Finally, older people often mistake the symptoms of HIV/AIDS for the aches and pains of normal aging, so they are less likely to get tested (Centers for Disease Control and Prevention, 2013). Signs of HIV/AIDS include pneumonia, fatigue, rare cancers, tuberculosis, vaginitis, and/or dementia. A physician or nurse may suspect normal signs of aging as opposed to HIV/AIDS infection. All cases discovered must be reported to the state health department. OSHA’s Workplace Safety, Ergonomics, Lock Out/Tag Out, and Hazardous Communications Workplace safety is an area of focus for OSHA. We have already discussed one major employee (and resident) OSHA safety standard in the previous lesson on the topic of bloodborne pathogens. Another form of workplace safety is eliminating or minimizing situations that can lead‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ to workplace violence. Workplace violence can be defined as acts or threats of physical violence, harassment, intimidation, or other threatening disruptive behaviors. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers, and visitors. Homicide is currently the fourth leading cause of fatal occupational injuries in the United States. According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI), of the 4,547 fatal workplace injuries that occurred in the United States in 2010, 506 were workplace homicides. Homicide is the leading cause of death for women in the workplace. Certain factors have been identified that may increase the risk of violence for some workers at certain worksites. In nursing homes, these factors include the following: Working with volatile and/or unstable people Working alone or in isolated areas Providing services and care Time of day and location of work, such as working late at night Health care professionals are at high risk for workplace violence. The risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. OSHA can offer assistance to employers in creating a Workplace Violence Prevention Plan, which can be a separate workplace violence prevention program or can be incorporated into an injury and illness prevention program, employee handbook, or manual of standard operating procedures. OSHA’s website and the CDC have resources on workplace violence prevention in healthcare can be found. Nursing homes are considered a high risk industry for OSHA. According to OSHA statistics, nursing assistants had the highest rates of musculoskeletal disorders of all . occupations in 2010. The incidence rate of work-related musculoskeletal disorders for these occupations was 249 per 10,000 workers. This compares to the average rate for all workers in 2010 of 34. As such, OSHA issued guidelines in 2003 to provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities. Most commonly, many nursing home employees received back injuries due to moving residents. OSHA’s Ergonomic Guidelines are only an advisory, not a standard. They provide a roadmap for implementation of a nursing home safe lifting program. Because they are not a standard or regulation, they do not create any new OSHA duties. While specific measures may differ from site to site, OSHA recommends the following: Manual lifting of residents be minimized in all cases and eliminated when feasible (no lift policies). Employers implement an effective ergonomics process that: provides management support; involves employees; identifies problems; implements solutions; addresses reports of injuries; provides training; and evaluates ergonomics efforts. Infection Control in the Era of COVID-19 The OSHA guidelines elaborate on these recommendations and include additional information employers can use to identify problems and train employees. Of particular value are examples of solutions employers can use to help reduce MSDs in their workplace. Recommended solutions for resident lifting and repositioning are found in Section III, while recommended solutions for other ergonomic concerns are in Section IV of the guidelines. Nursing homes are a labor-intensive service industry. Making clear investments in employee safety can lead to lower costs and increased staff satisfaction. Employers can ensure that there are enough patient lifts available, which are in proper working condition, and that staff are trained in their use. It is important to train new staff at the beginning of their employment about workplace safety. Many organizations have safety committees that focus preventative efforts on workplace and resident safety issues. Administrators should discuss employee safety at every opportunity and consistently let staff know that they are cared about and management does not want them to get hurt. In 2020, OSHA issued extensive guidance on infection control in light of the COVID-19 pandemic. It is assumed that any healthcare employee who is infected with COVID-19 will have become infected as a result of employment. This will require filing the case as employment-related with either the state OSHA or the federal OSHA. If it is a serious infection or death, OSHA requires notification within 24 hours, while some state OSHA agencies have other requirements. Additionally, OSHA assumes that employees will have access to personal protective equipment, including fitting and training on the use of all PPE. The OSHA standard for the Control of Hazardous Energy (commonly referred to as “Lockout/Tagout”), Title 29 (CFR) Part , addresses the practices and procedures necessary to disable machinery or equipment, thereby preventing the release of hazardous energy while employees perform servicing and maintenance activities. This OSHA standard is one of the most often neglected and under-trained standards that apply to nursing homes. However, this important standard can save a life. In nursing homes, powered equipment is plentiful and at times becomes damaged or inoperable. The standard sets forth requirements to protect employees working on electric circuits and equipment and with any type of energy. Lockout and tagging procedures apply frequently to maintenance personnel, housekeepers, dietary staff, and direct patient care staff who use a number of different types of equipment from vacuum cleaners, emergency generators, electric beds, patient lifts, electric wheelchairs, mixers, blenders, and meat slicers. Employees servicing or maintaining machines or equipment may be exposed to serious physical harm or death if hazardous energy is not properly controlled. The “lockout/tagout” standard establishes the employer’s responsibility to protect employees from hazardous energy sources on machines and equipment during service and maintenance. The standard gives each employer the flexibility to develop an energy control program suited to the needs of the particular workplace and the types of machines and equipment being maintained or serviced. This is generally done by affixing the appropriate lockout or tagout devices to energy-isolating devices and by de-energizing machines and equipment. Employees must be trained to ensure that they know, understand, and follow the applicable provisions of the hazardous energy control procedures. The training must cover at least three areas: (1) aspects of the employer’s energy control program, (2) elements of the energy control procedure relevant to the employee’s duties or assignment, (3) and the various requirements of the OSHA standards related to lockout/tagout (OSHA, 2013). Finally, we will review the Hazard Communication Program (HCP) which is based on the requirements of the OSHA Hazard Communications Standard, 29 CFR . This standard is often referred to as “Haz Comm” and its purpose is to ensure all chemical hazards in the workplace are identified, evaluated, and communicated to employees. This standard requires a company policy, labeling of containers, preparation and distribution of material safety data sheets (MSDS), and employee training and information regarding chemical hazards and protective measures. In addition to the HCP standard, many states have a “right to know” law. This OSHA standard is slated for a major revision in 2015 (delayed from an expected 2013 implementation). The MSDS requirement will change to an international Safety Data Sheet format. OSHA requires certain recordkeeping responsibilities, particularly the public posting of an OSHA 300 log each February. This form documents and classifies recordable work-related injuries. Because OSHA is tasked with ensuring workplace safety, OSHA surveyors may come to inspect at any time, and their reasons for inspection range from complaint calls, special programs that target high-injury employers, or random visits. Employers may ask OSHA staff to provide consultation assistance at no cost. OSHA will often visit when there has been serious employee injury or death in a workplace. Significant citations and penalties can be levied against violators of OSHA standards with fines up to $70,000 per serious violation. Nursing home administrators must be fully versed in the OSHA standards and guidelines and need to ensure proper policies, protocols, and staff training is in place. Resident and staff safety must be a priority of all administrators. References AHCA/NCAL. (2010). Report of Findings: Nursing Facility Staffing Survey. Retrieved March 2021. CMS. Nursing Home Data Compendium (2010). (No longer available online) National Institutes of Health. (2017, April 17). HIV and older adults. Retrieved March 2021 Occupational Safety and Health Administration (OSHA). Nursing Homes and Personal Care Facilities Standards. Retrieved March 2021 Occupational Safety and Health Administration (OSHA). COVID 19 and OSHA. Retrieved March 2021 Townsend, J. E., & Davis, W. E. (2011, August). The Principles of Health Care Administration. Shreveport, LA: BNB Systems, pp. 268-279. Correct spelling and sentence structure are very important. One strategy is to have someone proofread your assignments. Do not simply copy the text material. Be sure to support any arguments with details and facts. Do not cut and paste regulatory language citations. Complete sentences are required in each written assignment. Provide detail, thoughtful analysis, and articulate responses in each written answer. Avoid generalizations in your answers. Student grading is primarily based on how completely the questions are answered in the written assignments. Read the questions carefully and be sure to answer what is asked. Many questions have multiple parts, so be sure to a‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍nswer each part and label your answers.

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