(July 2, 2014): The Occupational Safety and Health Administration (OSHA) is an agency of the United Stated Department of Labor. Its purpose is assure safe and healthy working conditions for all working men and women by setting and enforcing standards and by providing education, training, outreach, and assistance. OSHA creates standards and guidelines that apply to every workplace in the country, including medical offices. Physicians and staff should regularly receive training and review office policies and procedures to be sure that they are in compliance with all required federal regulations, including those OSHA sets forth. For physicians, whether certain protocols and procedures apply to them will depend on their practice type and who they serve. However, there are certain physician office OSHA standards that will apply to any medical office, and these are listed below. The standards cited most frequently in physician office inspections are bloodborne pathogens and hazard communication. Less frequently cited standards are sanitation, mean of egress, personal protective equipment, respiratory protection, and medical services and first aid.
I. Bloodborne Pathogens Standard:
Some basic requirements of the OSHA Bloodborne Pathogens standard include:
- A written exposure control plan that needs to be updated annually.
- Consideration, implementation, and use of safer engineered needles and sharps.
- Use appropriate personal protective equipment.
- Hepatitis B Vaccine (HBV) provided to exposed employees at no cost.
- Medical follow-up in the event of an “exposure incident.”
- Use of labels or color-coding for items such as sharps disposal boxes, containers for regulated waste, contaminated laundry, and certain specimens.
- Employee training at the time of initial employment and at least annually thereafter.
- Proper containment of all regulated waste.
Because of turnover and expense considerations, some practices wait until after the new-employee probation period to offer the HBV. This is one of the more frequent cited bloodborne pathogen violations found during OSHA inspections, and the average initial fine is $1,717. Waiting to administer HBV is not complaint unless the new-employee probation period is only 10 working days.
II. Hazard Communication Standard:
The hazard communication standard is sometimes called the “employee right-to-know” standard. It requires employee access to hazard information. The basic requirements include:
- A written hazard communication program.
- A list of hazardous chemicals used or stored in the office.
- A copy of the Material Safety Data Sheet (MSDS) for each chemical used or stored in the office.
- Employee training at hiring and whenever the employer introduces new physical or health hazards into the workplace.
An office does not need MSDSs for household products used in the workplace as long as employees use the product for the same duration and frequency as the typical consumer.
III. Ionizing Radiation Standards:
This standard applies to facilities that have an x-ray machine and requires the following:
- A survey of the types of radiation used in the facility, including x-rays.
- Restricted areas to limit employee exposures.
- Employees working in restricted areas must wear personal radiation monitors.
- Caution signs in and on rooms and equipment.
IV. Electrical Standards:
OSHA electrical standards apply to electrical equipment and wiring in hazardous locations. These standards address electrical safety requirements to safeguard employees. For example, if a practice uses flammable gases, they may need special wiring and equipment installation.
V. Medical Records – Laws and Confidentiality Standards:
It is critical that physicians understand the regulations surrounding medical records. Most physicians and their staff are familiar with laws that affect information collected in medical records, including the Health Insurance Portability and Accountability Act (HIPAA) and the Americans with Disabilities Act Amendments Act (ADAAA). Individual states also have laws about the privacy and confidentiality of personal medical records.
OSHA has its own requirements for medical records. This provision requires employers to retain occupational medical and exposure records for 30 years after termination of a worker. The purpose of this requirement is to provide access to the records for employees and their representatives after a worker has left employment. Employers must give employees access to these records at no cost to them within 15 days of the request.
VI. Other Physician Office OSHA Standards and Considerations:
In addition to the standards discussed above, physicians must identify all chemical, biological, chemical, physical, ergonomic and psychological occupational health hazards. They must know and follow applicable state and local regulations related to issues such as pharmaceutical and vaccine storage and medical waste. Physicians must also be familiar with the screening protocols and procedures and calibration requirements for equipment, such as spirometers and audiometers. These are only a number of physician office OSHA standards that pertain specifically to medical environments. Physicians must review (or create) policies and procedures to assure compliance with all OSHA standards as well as compliance with other certification and licensing bodies.
VII. Final Remarks:
OSHA regulations must be implemented in every physician’s office. OSHA may perform random compliance audits, and the fines for willful negligence are steep. Physicians need to ensure their practices are in compliance with OSHA on all standards, and that they maintain an OSHA manual, poster, and all other required documentation.