The Dragons of Healthcare Workplace Safety: HCS, SDS and GHS

Understanding The Hazardous Communication Standard, Safety Data Sheets (SDS), The Globally Harmonized System of Classification and Labeling of Chemicals (GHS) and how to properly implement them to insure workplace safety and comply with OSHA.

We at HCSI train healthcare professionals and their staff members on the Federal OSHA requirements for medical providers. Even though our training covers all required areas such and The Hazard Communication Standard, Safety Data Sheets, GHS labeling rules, etc., we occasionally get a frantic call from a confused practice manager or compliance officer after a friendly visit by an OSHA inspector.  Even though they were trained on these subjects, they invariably did not take the time to implement the training and translate it into the preparation of their site specific required safety and regulatory documentation. Once again, the classic saying, perhaps older then the dragons of ancient lore, rears it's ugly head... "If it wasn't documented, it never happened."

All hazardous chemicals found in the workplace/practice must be identified and a Master List must be compiled containing the names of products, their manufacturers and their chemical components. This Master List can be compiled from information gained from a list of OSHA regulated substances such as the NIOSH Pocket Guide to Chemical Hazards.

Safety Data Sheets (SDS) [previously called Material Safety Data Sheets (MSDS) which are now obsolete and superseded by the GHS Global Harmonized Standard implemented in 2013 replacing MSDSs with SDSs] are forms generally provided by chemical manufacturers that convey hazard-related information on chemicals and hazardous substances you use in your workplace.  It is important that employees know how to interpret the information found on each SDS, which describes the chemical composition, health and physical hazards and safe handling and emergency procedures for all products containing hazardous substances. 

In the U.S., the Occupational Safety and Health Administration (OSHA) requires that SDSs be readily available to all employees for potentially harmful substances handled in the workplace under the Hazard Communication regulation. The SDSs are also required to be made available to local fire departments and local and state emergency planning officials under Section 311 of the Emergency Planning and Community Right-to-Know Act. The American Chemical Society defines Chemical Abstracts Service Registry Numbers (CAS numbers) which provide a unique number for each chemical and are also used internationally in SDSs.

In 2012, the US adopted the 16 section Safety Data Sheet to replace Material Safety Data Sheets. This became effective on December 1, 2013. These new Safety Data Sheets comply with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). By June 1, 2015, employers were required to have their workplace labeling and hazard communication programs updated as necessary – including all MSDSs replaced with SDS-formatted documents.

Many companies offer the service of collecting, or writing and revising, data sheets to ensure they are up to date and available for their subscribers or users. Some jurisdictions impose an explicit duty of care that each SDS be regularly updated, usually every three to five years. However, when new information becomes available, the SDS must be revised without delay.

Hazard Communication Standard

The Hazard Communication Standard (HCS) is now aligned with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). This update to the Hazard Communication Standard (HCS) provides a common and coherent approach to classifying chemicals and communicating hazard information on labels and safety data sheets. This update will also help reduce trade barriers and result in productivity improvements for American businesses that regularly handle, store, and use hazardous chemicals while providing cost savings for American businesses that periodically update safety data sheets and labels for chemicals covered under the hazard communication standard.

In order to ensure chemical safety in the workplace, information about the identities and hazards of the chemicals must be available and understandable/(i.e. training provided) to workers. OSHA's Hazard Communication Standard (HCS) requires the development and dissemination of such information:

• Chemical manufacturers and importers are required to evaluate the hazards of the chemicals they produce or import, and prepare labels and safety data sheets to convey the hazard information to their downstream customers;
• All employers with hazardous chemicals in their workplaces must have labels and safety data sheets for their exposed workers, and train them to handle the chemicals appropriately. 

Major changes to the Hazard Communication Standard 

• Hazard classification: Provides specific criteria for classification of health and physical hazards, as well as classification of mixtures.
• Labels: Chemical manufacturers and importers will be required to provide a label that includes a harmonized signal word, pictogram, and hazard statement for each hazard class and category. Precautionary statements must also be provided.
• Safety Data Sheets: Will now have a specified 16-section format.
• Information and training: Employers are required to train workers on the new labels elements and safety data sheets format to facilitate recognition and understanding.

GHS Pictograms

As of June 1, 2015, the HCS requires that new SDSs to be in a uniform format, and include the section numbers, the headings, and associated information under the headings below:

Section 1, Identification includes product identifier; manufacturer or distributor name, address, phone number; emergency phone number; recommended use; restrictions on use.

Section 2, Hazard(s) identification includes all hazards regarding the chemical; required label elements.

Section 3, Composition/information on ingredients includes information on chemical ingredients; trade secret claims.

Section 4, First-aid measures includes important symptoms/effects, acute, delayed; required treatment.

Section 5, Fire-fighting measures lists suitable extinguishing techniques, equipment; chemical hazards from fire.

Section 6, Accidental release measures lists emergency procedures; protective equipment; proper methods of containment and cleanup.

Section 7, Handling and storage lists precautions for safe handling and storage, including incompatibilities.

Section 8, Exposure controls/personal protection lists OSHA’s Permissible Exposure Limits (PELs); ACGIH Threshold Limit Values (TLVs); and any other exposure limit used or recommended by the chemical manufacturer, importer, or employer preparing the SDS where available as well as appropriate engineering controls; personal protective equipment (PPE).

Section 9, Physical and chemical properties lists the chemical's characteristics.

Section 10, Stability and reactivity lists chemical stability and possibility of hazardous reactions.

Section 11, Toxicological information includes routes of exposure; related symptoms, acute and chronic effects; numerical measures of toxicity.

Section 12, Ecological information*

Section 13, Disposal considerations*

Section 14, Transport information*

Section 15, Regulatory information*

Section 16, Other information, includes the date of preparation or last revision.

*Note: Since other Agencies regulate this information, OSHA will not be enforcing Sections 12 through 15 (29 CFR 1910.1200(g)(2)).

Employers, please remember to periodically review and update your hazardous substance/chemicals Master List and ensure your SDSs reflect those changes and are readily accessible, readable and also understandable to your employees as well as any fire department personnel, inspectors and/or government officials. Annual OSHA training is also required to ensure your staff is educated, aware and updated on these and other vital workplace safety issues.

Protecting your employees, patients and your office's regulatory reputation is an ongoing process requiring diligence and oversight. You can not simply take an apprentice course in the basics of fending off dragons in the hopes of never encountering one of the dreaded beasts. The knighthood of compliance (OSHA or otherwise) requires the quest of discovering your office's site specific situations, knowing your procedures along with the discipline of documentation and the situational awareness to defend against the dragons of workplace safety and regulatory compliance. 

Source(s): https://www.hcsiinc.com, https://www.cdc.gov/niosh/npg/, https://www.osha.gov/dsg/hazcom, https://en.wikipedia.org/

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OSHA Slams Northridge Hospital for Health and Safety Violations

OSHA COMPLIANCE IS CRITICAL

State workplace safety regulators fined the operator of Northridge Hospital Medical Center about $44,125 for violations that potentially exposed the hospital’s 1,700 employees to non-compliance health hazards.

Dignity Health was cited after Cal/OSHA determined that the hospital failed to record information in over a dozen cases where hospital workers were stuck with needles, and failed to provide closeable containers in emergency rooms that would keep biohazard waste from spilling, according to the state agency.

Northridge Hospital said in a statement that it is working “diligently” to address the agency’s findings.

“We have a longstanding relationship with Cal/OSHA and appreciate the regulatory body working with us to ensure the safety of our employees,” according to the hospital.

Cal/OSHA’s Van Nuys office opened an investigation in June after receiving a complaint, resulting in 13 health code violations, regulators said.

“California’s health and safety requirements are some of the strongest in the nation, and they’re meant to prevent hospital workers from becoming hospital patients,” Cal/OSHA Chief Juliann Sum said.

The findings included violations of bloodborne pathogens precautions, which require employers to protect workers from coming into contact with blood or other disease-carrying body fluids, according to Cal/OSHA.

Cal/OSHA also issued general and regulatory violations because Dignity Health kept broken gurneys in the working area, skipped essential elements of training employees in safe patient handling, and failed to take corrective action after accidents occurred, regulators said.

In summary, there were four serious violations of the bloodborne pathogens standard, which requires employers to protect workers from coming into contact with blood or other disease-carrying body fluids. A serious violation is cited when there is a realistic possibility that death or serious harm could result from the actual hazardous condition. In this case, the serious violations included:

• Failure to gather information required by the Sharps injury log, such as type and brand of needles involved in the 18 injury cases. The employer had no procedure in place to review the log, or to solicit required input from employees about factors contributing to contaminated needle injuries. Well-kept injury logs, and their regular review, help to identify the causes of injuries and prevent future occurrences.

• Failure to provide containers that would prevent spillage or protrusion of contaminated needles in emergency treatment and trauma rooms. Additionally, the employer did not provide readily accessible hand washing facilities for emergency room employees.

• Failure to provide appropriate sizes of gloves for employees using the medication cart in the trauma room and the after-hours intake area.
Cal/OSHA also issued eight general and regulatory violations because Dignity Health kept broken gurneys in the working area, skipped essential elements of training employees in safe patient handling, and failed to take corrective action after accidents occurred. 

Sources: Northridge-Chatsworth Patch, stateofreform.com

For more information on this and other healthcare compliance topics related to HIPAA, OSHA, Medicare and HR, simply email your questions to support@hcsiinc.com, 
visit our website at http://www.hcsiinc.com or post a question on our LinkedIn group at: http://bit.ly/1FWmtq6

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Protecting Employees from Workplace Violence

Being Aware and Having an Emergency Action Plan

The December 2nd, 2015 shooting in San Bernardino California, where 14 people were shot to death and 21 were injured at an office gathering, is a sobering reminder that violence in the workplace is an issue of concern for all of us. For employers, it is critical to ensure that all employees know the company's safety and violence prevention policies and procedures. In addition, companies can offer additional protections:

Hiring

• Verify information on all new hires through reference checking.
• Screen applicants by conducting background checks. Condition offers of employment upon the completion of background checks, drug tests or medical exams.

Workplace Analysis

• Review workers’ compensation records and illness claims to identify patterns of assault or other workplace violence. Understand industry trends and specific job exposures.

Employment

• Have a clear, written policy protecting employees from harassment, threats and intimidation. Policies should note that any complaints of harassment or threats will be investigated fully and appropriate steps taken, including discipline and discharge.
• Establish a complaint/grievance procedure.
• Establish/communicate how to access employee assistance program (EAP) services.
• Offer outplacement counseling to employees being laid off or terminated.

Security

• Consider implementing the following security measures: monitoring systems, limited access key cards, employee identification cards, emergency warning systems, security guards, visitor sign-in policies, security escorts in case of emergencies.

Crisis Plan

Develop a crisis plan that outlines how to report incidents of workplace violence, instructions on who to notify and:

• How to assess the situation, get help, warn other employees and secure the workplace.
• When and how to involve the police and gather information to assist an investigation.
• Follow-up activities like debriefing employees, resuming operations and long-term planning.

All employers should and probably do maintain an evacuation plan, but few employees even drill about the plan.  Moreover, responding to a tornado, hurricane or other natural disaster is far different from responding to a fire, explosion, shooting, or collapse of the electrical grid. 

•          Have you as an employer even thought about how you should respond to such events and protect your employees? 
•          Do you maintain an Emergency Ection Plan (EAP) under OSHA regulations? 
•          Do you even know what triggers the obligation to have an EAP?

There is much talk about workplace violence, but have you assessed your operation to determine where risks are presented?  Do you have employees making deliveries or going to customers’ homes unaccompanied? Have you professionally assessed security for entrance and exits?  Do management and HR know when they should be concerned about potentially dangerous employee behavior and what to do next?

If your answer is to simply point to the binder on a shelf or to be self assured that you have “competent people to take care of such matters,” then perhaps it is time to roll up your sleeves and check.

OSHA Focus on Workplace Violence

If you want additional motivation, OSHA is dead serious about inspecting employers for workplace violence exposures and issuing citations under its general duty powers. 

Special Focus on Workplace Violence in Healthcare

OSHA is also quite serious about conducting health care and hospital inspections which focus on workplace violence and ergonomic concerns.

See Also

• OSHA issues tools to help prevent workplace violence in healthcare settings
• Implementing an Emergency Action Plan
• How would you respond to an active shooter at your company?
• If there is a workplace shooting, don't just lie down and be a target
• Rules on injuries sustained during business travel
• Managing: Can I fire an employee over the phone?

Sources: HCSI, Howard A. Mavity @ http://www.lexology.com, Jay Starkman @ http://www.bizjournals.com 

Image credit: Chris Kuhlman 

For more information on this and other healthcare compliance topics related to HIPAA, OSHA, Medicare and HR, simply email your questions to support@hcsiinc.com, 
visit our website at http://www.hcsiinc.com or post a question on our LinkedIn group at: http://bit.ly/1FWmtq6

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OSHA Means Business Going Forward

OSHA Now Targeting The Health Care and Nursing Care Industries
Here’s more evidence your company needs to stay current on safety training: OSHA fines are heading skyward.  

Since 2010, the number of companies facing total OSHA fines above $100,000 has tripled.

This month, OSHA issued three penalties that topped one-million dollars and levied nearly a dozen citations carrying six-figure fines.

There’s more: Outgoing GOP house speaker John Boehner’s final peace offering – negotiating a compromised budget deal that would extend the debt limit and boost spending – took labor officials by surprise after finding that the agreement included a provision to hike OSHA fines nearly 50% in 2016.

The House approved the bill Oct. 28 and the Senate was scheduled to consider it Oct. 29. The bill includes a provision to adjust OSHA penalties annually based on the inflation rate.

Repeat and willful violations – which carry a maximum of $70,000 in penalties – contributed to the high dollar value of these fines. Machine guarding, lockout/tagout, trenching and fall hazards were among the common citations.

Here’s a sampling of October’s enforcement activities:

• Regulators hit a Nebraska cleaning company with 30 citations and $963,000 in fines after a railcar exploded, killing two employees and injuring a third. OSHA said the company sent the workers to clean a tanker car filled with dangerous fumes despite warnings that the air quality inside the car showed a high risk of explosion.
• Troubled Midwest furniture giant Ashley Furniture – already facing $1.7 million in OSHA fines from an inspection earlier this year – was hit for lockout/tagout hazards carrying $431,000 in penalties. In February, OSHA leveled 38 violations after inspectors discovered there were more than 1,000-work-related injuries at the plant over a 3 1/2 year period.
• An Ohio chicken processing facility found itself facing $414,000 in fines after two workers were maimed while attempting to clean unguarded machines. Penalties levied against Case Farms now total over $1.4 million.
• A commercial laundry company was hit with $305,300 in fines for repeatedly exposing workers to machine hazards. Three years ago, a 24-year old worker was killed when he was crushed by a conveyor belt.
• OSHA orders pilot to be reinstated after being fired for refusing to fly unsafe medical transport helicopter
  A pilot working for Air Methods Corp. was illegally terminated for refusing to fly a medical transport helicopter with a faulty emergency locator transmitter. Following an investigation, OSHA ordered the company reinstate the pilot, pay $166,000 in back wages and damages and remove disciplinary information from the pilot’s personnel record. The company must also provide whistleblower rights information to all employees.

The Occupational Safety and Health Administration (“OSHA”) recently intensified its scrutiny of the health care and nursing care industries. On June 25, 2015, the agency announced a new enforcement initiative targeting inpatient health care and nursing care facilities. But this increased scrutiny of the health care and nursing care industries does not end there—OSHA is spreading its enforcement reach to other types of health care entities.

Recently, OSHA cited LifeFleet LLC, an Ohio medical patient transportation company, for training shortfalls and bloodborne pathogen violations. OSHA alleged multiple violations, including several costly willful violations, and is seeking fines totaling nearly $236,000—a notably large amount. Typically, the fines associated with OSHA citations are very low, unless they are associated with fatalities. There were no fatalities in this case.

In discussing the magnitude of the fines against LifeFleet, OSHA’s Cleveland Area Office Director Howard Eberts said, “Failing to protect workers from pathogens that can cause life-threatening diseases is unacceptable. As a medical service provider, LifeFleet should be setting the standard in employee protection – not ignoring it.”

What does this mean to health care and nursing care employers? OSHA is targeting all health care and nursing care facilities, not just inpatient facilities. The agency is sending a clear message to the health care and nursing care industries in issuing citations carrying unusually heavy fines.

Here are a few action steps that employers can take right now to prepare for an OSHA inspection:

• Conduct an internal OSHA compliance audit. The cost of conducting an internal audit and addressing hazards before an OSHA inspection is trivial by comparison.
• Review all health and safety training programs. Ensure that all employees have been thoroughly trained—and have received refresher training, when appropriate—on all aspects of the facility’s health and safety policies and that they can demonstrate that they understood the training. It is advisable to conduct a quiz after each training session in order for employees to demonstrate their comprehension of the training and to keep quiz results and training attendee lists on file.
• Consult with an OSHA attorney regarding preparations for an OSHA inspection. Most health care and nursing care employers have never experienced an OSHA inspection (LifeFleet, for example, had never been inspected before) and may not be aware of strategies that can be used to minimize work disruption during an inspection and reduce the likelihood of receiving an unwarranted citation.

Sources: Tim Gould - http://www.cfodailynews.com, http://www.oshalawupdate.com/, http://www.dol.gov/ 

For more information on this and other healthcare topics related to HIPAA, OSHA, Medicare and HR compliance please email support@hcsiinc.com or visit our website at http://www.hcsiinc.com 
Join our LinkedIn group at: http://bit.ly/1FWmtq6

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