1. OSHA Inspections Guidance and Procedure for when an Inspector visits your facility Hospital Fire Marshal’s AssociationMarch 20, 2009 Nick Pinizzotto, Associate Director, Emergency Management and Safety Programs University of Pennsylvania Health System

2. OSHA Occupational Safety & Health Administration Enforces worker safety in U.S. workplace Enforces worker safety in U.S. workplace Interaction with hospitals relatively infrequent but very routine Interaction with hospitals relatively infrequent but very routine Occasional worker complaints Occasional worker complaints Local Emphasis Program inspections Local Emphasis Program inspections Works with The Joint Commission thru the Alliance Agreement which promotes mutual effort toward safer healthcare workforce Works with The Joint Commission thru the Alliance Agreement which promotes mutual effort toward safer healthcare workforce Educational only Educational only No regulatory activity or information sharing between them No regulatory activity or information sharing between them

3. What Triggers an OSHA Visit? 1. Imminent Danger Death or serious physical harm likely Death or serious physical harm likely 2. Fatality or Catastrophe Event causing fatality or hospitalization of > 3 employees Event causing fatality or hospitalization of > 3 employees 3. Complaints Employee complaints Employee complaints 4. Programmed Inspections Focused awareness on higher risks Focused awareness on higher risks

4. Complaints Can occur in 1 of 2 ways Standard(Informal) Complaint Standard(Informal) Complaint Employee calls or writes OSHA citing hazard Employee calls or writes OSHA citing hazard Formal Complaint Formal Complaint Employee must visit OSHA in person and make a formal complaint Employee must visit OSHA in person and make a formal complaint This would trigger an immediate inspection This would trigger an immediate inspection

5. Complaints Standard(Informal) Complaints are generally the top form of interaction w/ OSHA Standard(Informal) Complaints are generally the top form of interaction w/ OSHA Employee contacts OSHA regarding a hazard in their workspace. OSHA issues a “Notice of Alleged Hazard” to the employer stating the allegation Employee contacts OSHA regarding a hazard in their workspace. OSHA issues a “Notice of Alleged Hazard” to the employer stating the allegation Employer has 15 days to investigate and respond to OSHA in writing Employer has 15 days to investigate and respond to OSHA in writing OSHA reviews response, consults with employee OSHA reviews response, consults with employee Two possible courses of action: 1. Considered resolved but possibly subject to QA inspection frequency 2. Employee contests the response & Inspection occurs

6. Programmed Inspections Second most frequent type of interaction between OSHA and Hospitals Second most frequent type of interaction between OSHA and Hospitals Local Emphasis Program (LEP) Local Emphasis Program (LEP)  Focus on a particular industry and compliance with a governing standard  Creates awareness and increased compliance levels

7. Local Emphasis Programs Bloodborne Pathogens Standard OSHA was quite active with numerous BBP inspections between 2006 & 2008 OSHA was quite active with numerous BBP inspections between 2006 & 2008 Mostly focused on Practices but that typically brought them into the hospital setting Mostly focused on Practices but that typically brought them into the hospital setting Quiet period Quiet period Renewed focus possibly occurring Renewed focus possibly occurring Evidence of recent activity since 01/2009 Evidence of recent activity since 01/2009

8. When OSHA Visits Generally show up at the complaint or selected LEP location Generally show up at the complaint or selected LEP location Present identification and ask for the supervisor of the facility or safety person Present identification and ask for the supervisor of the facility or safety person Announce why they are there Announce why they are there STOP! What do you do?

9. Your Role Remain calm Remain calm Ask to see their identification if it wasn’t already presented Ask to see their identification if it wasn’t already presented Be courteous and professional Be courteous and professional Do not turn them away Do not turn them away Make them comfortable, ask them to have a seat while you contact the appropriate individuals Make them comfortable, ask them to have a seat while you contact the appropriate individuals CONTACT: Your Safety Office, Infection Control Office, your departmental or practice manager/supervisor CONTACT: Your Safety Office, Infection Control Office, your departmental or practice manager/supervisor Do not begin until Safety and Infection Control arrive Do not begin until Safety and Infection Control arrive Do not engage the inspector in a lot of conversation until Safety/IC arrive and the inspection formally begins Do not engage the inspector in a lot of conversation until Safety/IC arrive and the inspection formally begins Wait to answer any questions until the Safety and IC arrive Wait to answer any questions until the Safety and IC arrive

10. Safety Management & Infection Control Roles Once notified: Once notified:  Mobilize to the area while alerting your Support Team (EVS, HR Disability Management, Physical Plant, etc.)  Notifies Occupational Health Services of the department involved so that they are aware a request for vaccination records may occur Upon arrival: Upon arrival:  the inspection can begin

11. Support Team The Support Team can be many individuals or departments The Support Team can be many individuals or departments Some touring w/the inspection Some touring w/the inspection Others working behind the scenes to: Others working behind the scenes to:  Review areas if necessary and possible  Select employees to present for private interview  Retrieve departmental employee training records, OSHA 300 log, Needlestick log, Exposure Control Plan

12. The Inspection Generally 1-3 hours. Upwards of 1 full day but generally no longer Generally 1-3 hours. Upwards of 1 full day but generally no longer Possible return visit(s) Possible return visit(s) Employer representation (ideally by <4 people) Employer representation (ideally by <4 people) Safety Safety Infection Control Infection Control Practice or Departmental representative Practice or Departmental representative Other(s) Other(s) IMPORTANT! Never volunteer information, only provide answers to specific questions asked by the inspector IMPORTANT! Never volunteer information, only provide answers to specific questions asked by the inspector

13. The Inspection The OSHA inspector will: The OSHA inspector will:  hold an opening conference w/employer representatives  want to tour the department or visit a specific site of an alleged hazard  definitely spend time in labs (if you have them) looking at chemical usage  request the following:  a recent OSHA 300 log  a needle stick log  the Exposure Control Plan  Material Safety Data Sheets  possibly take photographs and/or conduct air sampling if warranted

14. The Inspection The OSHA inspector will: The OSHA inspector will:  most likely request to interview 2 or more employees privately  Will ask questions to verify training program, vaccination program, PPE access  Allow employees to share confidentially any worker safety concerns  May ask employee for home address and phone number (routine but NOT mandatory)  look at other safety hazards if any are present, even if it is unrelated to why they are there  hold a closing conference summarizing inspection, possible citations, need for additional information/documentation

15. Post Inspection A Satisfactory inspection? No further action A Satisfactory inspection? No further action Citations and Notification of Penalty sent requiring corrections within specified time frame. Citations and Notification of Penalty sent requiring corrections within specified time frame. With assistance from Counsel & Safety coordinates response, corrections, etc. With assistance from Counsel & Safety coordinates response, corrections, etc. A ‘Plan for Abatement’ of hazards is developed and implemented A ‘Plan for Abatement’ of hazards is developed and implemented May be a negotiation/challenge process between Counsel and OSHA May be a negotiation/challenge process between Counsel and OSHA Everything is documented Everything is documented

16. In Summary While OSHA interaction is not frequent, it is quite routine While OSHA interaction is not frequent, it is quite routine Written complaints sometimes come directly to Hospital Administration or the alleged hazard location Written complaints sometimes come directly to Hospital Administration or the alleged hazard location Complaints are time sensitive! Complaints are time sensitive! Get them to your Safety Office! Get them to your Safety Office!

17. In Summary If an inspector arrives, notify the Safety Office or Infection Control If an inspector arrives, notify the Safety Office or Infection Control DO NOT begin the inspection until they arrive DO NOT begin the inspection until they arrive Be prepared to have a private location where OSHA can interview employees Be prepared to have a private location where OSHA can interview employees Make sure employees are compliant on training, vaccination, etc. and you have up-to-date records Make sure employees are compliant on training, vaccination, etc. and you have up-to-date records

18. Your Employees OSHA uses employee knowledge to validate employer programs on OSHA Standards Make sure employees know the following: Make sure employees know the following: the concept of “Standard (Universal) Precautions” the concept of “Standard (Universal) Precautions” contact times for disinfectants contact times for disinfectants Sanicloth - 5 minutes, Clorox - 4 minutes, Virex 256 - 5 minutes Sanicloth - 5 minutes, Clorox - 4 minutes, Virex 256 - 5 minutes how to access MSDSs http://www.msdssource.com/search.php how to access MSDSs http://www.msdssource.com/search.phphttp://www.msdssource.com/search.php where the hospital Exposure Control Plan as well as a copy of the BBP Standard can be found where the hospital Exposure Control Plan as well as a copy of the BBP Standard can be found Employee training is up to date Employee training is up to date hepatitis B vaccination (or declination) and surface antibody testing is completed (records available in Occupational Medicine) hepatitis B vaccination (or declination) and surface antibody testing is completed (records available in Occupational Medicine) the location(s) of PPE (Personal Protective Equipment) the location(s) of PPE (Personal Protective Equipment) the importance of cleanliness/orderliness in Infection Control the importance of cleanliness/orderliness in Infection Control no food/drink in clinical areas no food/drink in clinical areas procedures for post exposure follow up procedures for post exposure follow up

19. Questions?