Occupational Safety and Health Administration (OSHA)

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Bloodborne Pathogens Standard: Implementing Bloodborne Pathogen/Exposure Control Plan in LTC Centers, Part 1https://www.ahcancal.org/News-and-Communications/Blog/Pages/Bloodborne-Pathogens-Standard-Implementing-Bloodborne-PathogenExposure-Control-Plan-in-LTC-Centers-Part-1.aspxBloodborne Pathogens Standard: Implementing Bloodborne Pathogen/Exposure Control Plan in LTC Centers, Part 12/21/2024 5:00:00 AM<p></p><div>In health care settings, especially in long term care (LTC) centers, the safety of residents and staff is connected. A clear example involves implementing a comprehensive Occupational Safety and Health Administration (OSHA)-compliant Bloodborne Pathogen (BBP)/Exposure Control Plan (ECP). It's important to emphasize the importance of aligning the BBP ECP with existing infection control plans for resident care. This alignment provides an organized and integrated approach. </div><div> </div><div>This article aims to identify and discuss the key requirements for establishing and implementing an effective ECP within LTC centers, emphasizing the integration of other infectious disease plans for safeguarding both health care workers and residents. </div><div> </div><div><span style="text-decoration:underline;">The OSHA Bloodborne Pathogens Standard</span>: </div><div><br></div><div>Enacted in 1991, the OSHA Bloodborne Pathogens Standard <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">1910.1030 - Bloodborne pathogens</a> provides the requirements to safeguard health care workers from the risks associated with exposure to bloodborne pathogens. For LTC centers, where residents often require medical procedures with bodily fluids and close interactions with health care workers, adherence to this standard is essential for the safety of both resident and employees. </div><div><br></div><div><strong>Key Requirements for Implementing an ECP:</strong> </div><div><br></div><div><ol><li>Exposure Determination  </li><li><span style="font-size:11pt;">W</span><span style="font-size:11pt;">ritten ECP </span></li><li><span style="font-size:11pt;">Universal Precautions, Procedural Controls, and PPE </span></li><li><span style="font-size:11pt;">Employee Training </span></li><li><span style="font-size:11pt;">Hepatitis B Vaccination </span></li><li><span style="font-size:11pt;">Post-Exposure Procedures </span></li><li><span style="font-size:11pt;">Medical Surveillance </span></li><li><span style="font-size:11pt;">Recordkeeping </span></li></ol></div><div><span style="font-size:11pt;"><em>This article expands on four of the eight above key requirements for development and implementation of an effective ECP: </em></span><br></div><div><br></div><div><ol><li><strong>Exposure Determination: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=examination%20and%20copying.-%2c1910.1030%28c%29%282%29%2cExposure%20determination.%2c-1910.1030%28c%29%282" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(c)(2) </strong></a><strong> <br></strong><br></li><ul><li><span style="font-size:11pt;">​​</span><strong>Job Classification and Task Analysis:</strong><br> <br><strong>​Requirement:</strong> Conduct a comprehensive evaluation of job classifications and associated tasks to identify positions with a potential risk of occupational exposure to bloodborne pathogens.<br> <br><strong>I</strong><span style="font-size:11pt;"><strong>mpl</strong></span><span style="font-size:11pt;"><strong>ementation: </strong>Clearly define each job role and analyze the specific tasks it entails. Determine which tasks involve contact with blood or other potentially infectious materials (OPIM). This analysis forms the basis for identifying exposure risks within different job categories. <br><br></span></li><li><span style="font-size:11pt;"><strong>Category Designation: </strong><br><br></span><strong>Requirement:</strong> Categorize job positions/descriptions into appropriate exposure risk categories as defined by OSHA. </li><ul><li><span style="text-decoration:underline;">​​Category I</span> includes job classifications in which <strong>all employees</strong> have a reasonably anticipated risk of exposure (i.e. RN, <span style="font-size:11pt;">LPN, CNA).  </span></li><li><span style="font-size:11pt;text-decoration:underline;">C</span><span style="font-size:11pt;"><span style="text-decoration:underline;">ategory II</span> comprises of job classifications in which po</span><span style="font-size:11pt;">tential exposures occur <strong>during specified tasks </strong>(i.e. a maintenance worker responsible for handling regulated waste).<br></span><span style="font-size:11pt;"><br><b>Implem</b></span><span style="font-size:11pt;"><strong>entation:</strong><strong> </strong>Assign each job position to the relevant exposure category based on the nature of tasks and the likelihood of exposure. This categorization guides the development of specific safety measures tailored to the different </span><span style="font-size:11pt;">levels of risk. <br><br></span></li></ul><li><strong>Regular Review and Update:<br></strong> <br><strong>Requirement:</strong> Conduct periodic reviews of exposure determinations to ensure they remain accurate and reflective of current job responsibilities, technological advancements, and changes in work practices.<br> <br><strong>Implementation:</strong> Establish a schedule for regular reviews of exposure determinations, incorporating updates as needed. Any alterations in job roles, tasks, or procedures that may affect exposure risks should trigger an immediate reassessment and update of exposure determinations. <br><br></li></ul><li><span style="font-size:11pt;"><strong>Written Exposure Control Plan: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=Control%20Plan.-%2c1910.1030%28c%29%281%29%28i%29%2c-Each%20employer%20having" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(c)(1)(i) </strong></a><strong> <br><br></strong></span></li><ul><li><span style="font-size:11pt;">​</span><strong>Scope and Application:</strong><br> <br><strong>Requirement:</strong> Clearly define the scope and application of the ECP, outlining the specific job classifications and tasks covered by the plan (as defined in your exposure determination). <br> <br><strong>Implementation:</strong> Detail the areas within the organization where the plan applies, specifying the job roles and tasks involving potential exposure to bloodborne pathogens. This provides clarity to employees regarding the applicability of the plan to their work responsibilities. <br><br></li><li><span style="font-size:11pt;"><strong>Control Measures and Implementation: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=1910.1030%28c%29%281%29%28ii%29%28B%29" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(c)(1)(ii)(B)</strong></a><strong> <br></strong><br></span><strong>Requirement:</strong> After defining the exposures and the employees involved, the rest of your written ECP will lay out how compliance with the OSHA standard is achieved.  <br><br><strong>I</strong><span style="font-size:11pt;"><strong>mplementation:</strong> Your program should include the following: </span></li><ul><li><span style="font-size:11pt;">​</span>Universal precautions, engineering, and work practice controls </li><li>Personal protective equipment (PPE) </li><li>Housekeeping, waste management, and laundry </li><li>Hepatitis B Vaccination </li><li>Post exposure evaluation and follow-up </li><li>Training and proper labeling </li><li>Annual review including safe needle device solicitations to employees </li><li>Maintaining records applicable to the ECP and Bloodborne Pathogens <br><br></li></ul></ul><li><span style="font-size:11pt;"><strong>Universal Precautions, Controls, and PPE 1910.1030(d) <br><br></strong></span></li><ul><li>​<strong>Universal Precautions Implementation: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=Methods%20of%20compliance%20--%2c1910.1030%28d%29%281%29%2c-General.%20Universal%20precautions" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(d)(1)</strong></a><br> <br><strong>Requirement:</strong> Clearly state in the ECP that universal precautions must be consistently applied to all patients, treating all blood and certain body fluids as potentially infectious. <br><br><strong>Implementation:</strong> Specify the use of universal precautions during any potential exposure to blood or other infectious materials. Emphasize the importance of hand hygiene, safe work practices, and the use of PPE to minimize the risk of transmission. <br><br></li><li><span style="font-size:11pt;"><strong>Engineering Controls and Safe Work Practices: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=potentially%20infectious%20materials.-%2c1910.1030%28d%29%282%29%2c-Engineering%20and%20work" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(d)(2) </strong></a><strong> <br></strong><br></span><strong>Requirement:</strong> Outline specific control measures and safe work practices to minimize or eliminate the risk of exposure. This includes the use of engineering controls, work practice controls, and PPE. <br><br><strong>Implementation:</strong> Detail the engineering controls in place, such as sharps disposal containers and safety devices. Specify the work practices employees must follow, including proper handling and disposal procedures. Additionally, describe the types of PPE provided and the situations in which they should be used. <br><br></li><li><span style="font-size:11pt;"><strong>PPE Selection, Provision, and Use: </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=will%20be%20taken.-%2c1910.1030%28d%29%283%29%2c-Personal%20protective%20equipment" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(d)(3) </strong></a><br><br></span><strong>Requirement:</strong> Clearly outline the types of PPE required for different tasks, ensuring accessibility and proper use. <br><br><strong>Implementation:</strong> Detail the specific PPE needed for various job functions within the ECP. This may include gloves, masks, eye protection, and gowns. Ensure that PPE is readily available, well-maintained, and replaced when damaged. Provide clear instructions on how to correctly put on, remove, and dispose of PPE. <br><br></li></ul><li><span style="font-size:11pt;"><strong>Employee Training </strong><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=a%20contrasting%20color.-%2c1910.1030%28g%29%282%29%2c-Information%20and%20Training" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(g)(2) </strong></a><br><br></span></li><ul><li><span style="font-size:11pt;">​</span><strong>​​ECP Awareness:</strong><br> <br><strong>Requirement:</strong> LTC staff must undergo initial and minimum annual training to understand and adhere to the center's ECP. <br><br><strong>Implementation:</strong> Training programs should specifically address the details of the ECP, ensuring that staff can effectively implement its components. This involves practical guidance on the correct utilization of PPE, understanding work practice controls, and familiarization with engineering controls within the LTC setting. <br><br></li><li><span style="font-size:11pt;"><strong>Training elements:  <br></strong><br></span><strong>Requirement: </strong>Staff must receive training that emphasizes adherence to safe work practices and procedures to prevent the transmission of bloodborne pathogens, as mandated by the Bloodborne Pathogens Standard. This includes proper handling and disposal of contaminated items, the correct use of PPE, and strict compliance with hygiene practices. <br><br><strong>I</strong><span style="font-size:11pt;"><strong>mplementation:</strong> Training modules should provide demonstrations and scenarios to ensure that staff can implement safe work practices effectively. This involves practical training on handling sharps, appropriate cleaning, and disinfection protocols, and understanding proper responses to potential exposure incidents. See minimum training program elements for details <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030#:~:text=shall%20be%20used.-%2c1910.1030%28g%29%282%29%28vii%29%2c-The%20training%20program" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><strong>1910.1030(g)(2)(vii) </strong></a></span></li></ul></ol></div><div><br></div><div><strong style="font-size:11pt;">Benefits of Compliance:</strong><span style="font-size:11pt;"> </span></div><div> </div><div>Exposure determination enables the identification of job positions and tasks carrying a risk of occupational exposure to bloodborne pathogens, allowing for targeted safety measures and employee training. This categorization ensures the customization of safety protocols based on varying exposure risks. Periodic reviews and updates of exposure determinations ensure the ECP remains current and adaptive to evolving responsibilities and technologies. </div><div> </div><div>On the other hand, a well-documented ECP provides clear and standardized guidance, serving as a training tool for employees and reducing confusion in infection control procedures. Moreover, it ensures legal compliance with OSHA regulations, mitigating the risk of regulatory penalties. The ECP's role is cumulative documentation of training records and exposure incidents, facilitating efficient communication during audits and underscoring the center's commitment to maintaining a safe working environment. Together, exposure determination and a written ECP are a foundation for preventing occupational exposure to bloodborne pathogens, safeguarding both health care workers and the center against potential risks. </div><div> </div><div>Bloodborne Pathogen ECP is a non-negotiable element of center OSHA compliance and safety management. By meeting these requirements, LTC centers create a safer environment, reinforcing their dedication to providing quality care while protecting the health and safety of both residents and staff. </div><div><br></div><div><strong>OSHA Model ECP: </strong> <br></div><div><br></div><div><ul><li>Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards (<a href="https://www.osha.gov/sites/default/files/publications/osha3186.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">PDF​</a>). OSHA Publication 3186-06N, (2003). </li></ul></div><div><br></div><div><strong class="ms-rteForeColor-2">NOTE</strong>: While model plans provide a valuable foundation, health care centers must understand the importance of customizing these OSHA standards to the unique characteristics and operational context of their center.  </div><div><br><br></div><p>​</p>In health care settings, especially in long term care centers, the safety of residents and staff is connected.
Maintaining Your Respiratory Protection Program in LTC Centers: Actions and Frequencieshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Maintaining-Your-Respiratory-Protection-Program-in-LTC-Centers-Actions-and-Frequencies.aspxMaintaining Your Respiratory Protection Program in LTC Centers: Actions and Frequencies2/13/2024 5:00:00 AM<p>​​<span style="font-size:11pt;">Long term care (LTC) centers must adhere to specific requirements for compliance with the Occupational Health and Safety Administration (OSHA) <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Respiratory Protection Standard (29 CFR 1910.134)</a>. The nature of airborne hazards, the presence of respiratory threats, the specific respiratory protection program, and the resulting compliance requirements will vary between organizations. Employers must recognize that once a Respiratory Protection Program (RPP) is established, ongoing maintenance is necessary to ensure compliance with the OSHA standard.  </span></p><p><span style="font-size:11pt;">The following are areas of a Respiratory Protection Program that likely require regular action by the organization: </span></p><div><ol><li><span style="font-size:11pt;">Training and Retraining: <br></span></li><ul><li><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134#:~:text=and%20remains%20legible.-%2c1910.134%28k%29%2c-Training%20and%20information" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span style="font-size:11pt;">​Section 1910.13</span><span style="font-size:11pt;">4(k)</span></a><span style="font-size:11pt;"> outlines comprehensive training requirements for employees using respirators in the workplace. Training should be easily understandable and recurrent, with an annual frequency and more frequent sessions as needed. <br></span></li><li>Recommendations: <br></li></ul><ol><ol><li><span style="font-size:11pt;">​​​</span><span style="font-size:11pt;">Conduct initial training before the employee must wear a respirator to cover respiratory hazards and proper respirator usage. </span></li><li><span style="font-size:11pt;">Conduct annual training </span><span style="font-size:11pt;">sessions covering respiratory hazards, proper respirator usage, and changes in the workplace affecting respirator use. </span><br></li><li><span style="font-size:11pt;">Retrain employees as necessary, particularly in response to workplace changes or if deficiencies in understanding or skills are identified. <br></span><br></li></ol></ol><li><span style="font-size:11pt;">Fit Testing: </span></li><ul><li><span style="font-size:11pt;">​</span><span style="font-size:11pt;"><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134#:~:text=on%20an%20employee.-%2c1910.134%28f%29%2c-Fit%20testing" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Section 1910.134(f)</a> addresses fit testing procedures and specifies the methods to assess the effectiveness of a respirator's seal. </span></li><li>Recommendations: <br></li></ul><ol><ol><li><span style="font-size:11pt;">​</span><span style="font-size:11pt;">Conduct fit testing before employees are required to use respirators.  </span></li><li>Conduct fit testing annua<span style="font-size:11pt;">lly for each employee required to wear a respirator. </span></li><li>Perform fit testing whenever there are changes in facial characteristics, respirator model or size, or other conditions impacting the respirator's fit. <br><br></li></ol></ol><li><span style="font-size:11pt;">Medical Evaluations: </span></li><ul><li><span style="font-size:11pt;">​​​​</span><span style="font-size:11pt;"><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134#:~:text=use%20a%20respirator.-%2c1910.134%28e%29%281%29%2c-General.%20The" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Section 1910.134(e)(1)</a> mandates medical evaluations to determine an employee's ability to use a respirator before fit testing or respirator use. </span></li><li><span style="font-size:11pt;">R</span><span style="font-size:11pt;">ecommendations: <br></span></li></ul><ol><ol><li><span style="font-size:11pt;">​​​​</span>Complete medical questionnaires and obtain clearance for employees before they are required to wear a respirator.</li><li><span style="font-size:11pt;"> </span>Ensure medical clearance whenever there is a significant change in an employee's health status. <br></li><li><span style="font-size:11pt;">NOTE: OSHA does not require annual medical evaluation or clearance.<br></span><br></li></ol></ol><li><span style="font-size:11pt;">Program Evaluation: </span><br></li><ul><li><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134#:~:text=202-219-4667%29.-%2c1910.134%28c%29%281%29%2c-In%20any%20workplace" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span style="font-size:11pt;">​​</span>Section 1910.134(c)(1)</a> underscores the importance of regularly reassessing the effectiveness of the respiratory protection program. </li><li>Recommendations:<br></li><p><span style="font-size:11pt;"></span></p></ul><ol><ol><li><span style="font-size:11pt;">​​​</span><span style="font-size:11pt;">Conduct an annual review and evaluation of the respiratory protection program to ensure ongoing effectiveness. </span></li><li>Assess incidents or near-misses related to respiratory protection and implement corrective actions. <br><br></li></ol></ol><li><span style="font-size:11pt;">Recordkeeping: </span></li><ul><li><span style="font-size:11pt;">​​</span><span style="font-size:11pt;"><a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134#:~:text=Proper%20respirator%20maintenance.-%2c1910.134%28m%29%2c-Recordkeeping.%20This" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Section 1910.134(m)​</a> mandates the maintenance of specific records related to the respiratory protection program. </span></li><li><span style="font-size:11pt;">Recommendations: <br></span></li></ul><ol><ol><li>Conduct an annual review of all records related to medical evaluations, fit testing, training, and other pertinent information. <br></li><li><span style="font-size:11pt;">Review and update the Respiratory Protection Plan annually. <br></span><br></li></ol></ol><li><span style="font-size:11pt;">Communication of Changes: </span><br></li><ul><li><span style="font-size:11pt;">​​</span>Recommendations: </li></ul><ol><ol><li><span style="font-size:11pt;">​​</span>C<span style="font-size:11pt;">ommunicate any changes in the workplace affecting the respiratory protection program to employees. </span></li><li><span style="font-size:11pt;">Update written procedures and documentation as necessary to reflect changes. </span><br></li></ol></ol></ol></div><div><br></div><div><span style="font-size:11pt;">A strong RPP in LTC centers requires regular maintenance and attention to OSHA standards. As shown above, these actions include consistent training, fit testing, medical evaluations, thorough program assessments, recordkeeping, and communication. Employers should actively review and update their programs to continuously meet compliance requirements and encourage employee safety amid changing workplace conditions. </span></div><div><br>​<br></div><p>​</p>Long term care centers must adhere to specific requirements for compliance with the Occupational Health and Safety Administration Respiratory Protection Standard (29 CFR 1910.134).
Navigating “Safety” in Long Term Care Centers: Separating the Roles of OSHA and the CMS requirements for Emergency Preparednesshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Navigating-Safety-in-Long-Term-Care-Centers-Separating-the-Roles-of-OSHA-and-the-CMS-requirements-for-Emergency-Preparedn.aspxNavigating “Safety” in Long Term Care Centers: Separating the Roles of OSHA and the CMS requirements for Emergency Preparedness2/6/2024 5:00:00 AM<p><strong style="font-size:11pt;">​Continuation: </strong><br></p><div><span style="font-size:11pt;">In this third article regarding the connection between the Occupational Safety and Health Administration (OSHA) and the Centers for Medicare & Medicaid Services (CMS) Life Safety and Emergency Preparedness (EP) Requirements, the focus will be on how OSHA’s regulations overlap with CMS’ EP requirements, found in 42 CFR 483.73 (Appendix Z).  </span><br></div><div> </div><div>It’s important to note that CMS’ EP requirements <strong>do NOT</strong> apply to assisted living, however any OSHA requirements do apply. </div><div> </div><div><strong>Emergency Preparedness-Overview:</strong> </div><div><br></div><div><ul><li><strong>Emergency Preparedness:</strong> CMS established specific requirements for emergency preparedness in nursing communities that became effective in 2017. The CMS rule, commonly known as the Emergency Preparedness Rule, applies to various health care providers, including nursing communities. Emergency preparedness is typically surveyed by the state survey agency in conjunction with the Life Safety Code survey.  <br><br>Key components of the CMS Emergency Preparedness Rule for nursing communities <span style="font-size:11pt;">include, but are not limited to: </span></li><p><span style="font-size:11pt;">​<br></span></p></ul><ol><ol><li><span style="font-size:11pt;">​​​</span><span style="font-size:11pt;">​</span><span style="font-size:11pt;"><span style="text-decoration:underline;">Emergency Plan</span>: Providers are required to develop and maintain an emergency plan that addresses potential emergencies specific to their geographic location. This plan should include strategies for addressing both natural and man-made disasters. </span></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Policies and Procedures</span>: Nursing homes must have policies and procedures in place to implement the emergency plan. These should cover various aspects, including communication, patient tracking, and coordination with local emergency management agencies. </span><br></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Communication Plan</span>: Nursing homes are required to establish a communication plan that ensures timely and effective communication during emergencies. This includes communication with staff, residents, families, and external entities. </span><br></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Training and Testing</span>: Nursing home providers must conduct regular training for staff to ensure they are familiar with emergency procedures. Additionally, they are required to conduct regular testing and drills to assess the effectiveness of their emergency plans. </span><br></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Integrated Healthcare Systems</span>: Nursing home communities are encouraged to coordinate their emergency plans with other health care providers and community resources to ensure a seamless response to emergencies. </span></li></ol></ol><ul><li><strong>OSHA:</strong> OSHA does not have regulations or standards that specifically address emergency preparedness in long term care communities, including assisted living. However, OSHA does have general requirements that may indirectly relate to emergency preparedness and employee safety during emergencies, such as emergency evacuation procedures, personal protective equipment, infection control and respiratory protection.  </li></ul></div><div><br></div><div><strong>Emergency Preparedness - Compare and Contrast of Key Compliance Items: </strong></div><div><br></div><div><ol><li><strong>Emergency Evacuation Plans:</strong> <br><br></li><ol><ul><li><span style="font-size:11pt;">​</span><span style="font-size:11pt;">​</span><strong>Emergency Preparedness</strong>: CMS mandates the development and implementation of comprehensive emergency evacuation plans that consider various potential emergencies, including fires and natural disasters. These plans outline procedures for the safe and orderly evacuation of residents, including the identification of evacuation routes and the assignment of responsibilities to staff members. <br><br></li><li><span style="font-size:11pt;"><strong>OSHA</strong>: OSHA's Emergency Action Plan standard <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.38" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">1910.38 - Emergency action plans. | Occupational Safety and Health Administration (osha.gov) </a>requires employers to develop and implement emergency action plans. These plans must include procedures for the evacuation of employees and, where applicable, residents during emergencies. <br></span><br></li></ul></ol><li><span style="font-size:11pt;"><strong>Communication Systems: <br></strong></span><br></li><ol><ul><li><span style="font-size:11pt;">​​</span><strong>Emergency Preparedness</strong>: CMS emphasizes the importance of effective communication during emergencies. Communities are required to have communication systems in place to relay information to staff, residents, and, if necessary, external emergency response entities. This includes methods for notifying individuals about emergencies and providing clear instructions. <br><br></li><li><span style="font-size:11pt;"><strong>OSHA</strong>: OSHA regulations also highlight the importance of communication during emergencies (29 CFR 1910.38). Emergency action plans must include procedures for reporting emergencies, including a method for employees to report emergencies or other dangerous situations. <br></span><br></li></ul></ol><li><span style="font-size:11pt;"><strong>Training and Drills: <br></strong></span><br></li><ol><ul><li><span style="font-size:11pt;">​​</span><strong>Emergency Preparedness</strong>: CMS has specific requirements for training and drills to ensure that staff and residents are familiar with emergency procedures. This includes conducting evacuation drills, training on the use of emergency equipment, and educating individuals on their roles and responsibilities during emergencies. <br><br></li><li><span style="font-size:11pt;"><strong>OSHA</strong>: OSHA's Emergency Action Plan standard emphasizes the need for employee training (29 CFR 1910.38). Employers, including long-term care centers, must ensure employees are familiar with the emergency action plan, including evacuation procedures, and conduct regular drills to evaluate its effectiveness. </span><br></li></ul></ol></ol></div><div><br></div><div><span style="font-size:11pt;"><strong>Differences and Synergies: </strong></span></div><div><br></div><div>The CMS rules and OSHA regulations overlap on certain aspects of emergency preparedness, yet each has distinct focuses. Both emphasize the importance of comprehensive emergency preparedness in health care settings, including long term care centers.  </div><div> </div><div>CMS rules, particularly the Emergency Preparedness Rule, require providers to develop and implement plans addressing various emergencies. This encompasses evacuation procedures, communication plans, and coordination with external entities.  </div><div> </div><div>OSHA, while not having specific regulations dedicated to health care emergency preparedness, mandates general emergency action plans for workplaces, emphasizing evacuation procedures and employee training.  </div><div> </div><div><strong>Conclusion: </strong></div><div> </div><div>The CMS rules specifically address the safety and needs of health care recipients and their caregivers, ensuring continuity of care during emergencies, while OSHA's focus encompasses the safety of employees. Aligning with both sets of regulations ensures a universal approach to emergency preparedness, safeguarding the well-being of both health care recipients and staff in health care settings. </div><div> <br></div><p>​</p>In this third article regarding the connection between OSHA and CMS Life Safety and EP Requirements, the focus will be on how OSHA’s regulations overlap with CMS’ EP requirements, found in 42 CFR 483.73 (Appendix Z).
Navigating “Safety” in Long Term Care Facilities: Separating the Roles of OSHA and the Life Safety Code for Fire Safetyhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Navigating-Safety-in-Long-Term-Care-Facilities-Separating-the-Roles-of-OSHA-and-the-Life-Safety-Code-for-Fire-Safety.aspxNavigating “Safety” in Long Term Care Facilities: Separating the Roles of OSHA and the Life Safety Code for Fire Safety1/30/2024 5:00:00 AM<p></p><div>As mentioned in a previous article, OSHA’s regulations overlap with the Centers for Medicare and Medicaid (CMS) Federal and State requirements in many areas. Most common crossover occurs between certain OSHA regulations and CMS’ Life Safety Code (LSC). This article will examine another common area of overlap with fire safety. </div><div><br></div><div><strong>Fire Safety-Overview:<br><br></strong></div><div><ul><li>LSC: Places a comprehensive emphasis on fire safety within the entire facility, including resident rooms, common areas, and corridors. It includes requirements for fire detection and alarm systems, fire-rated construction, and measures to prevent the spread of fire.<br><br></li><li>OSHA: While OSHA has specific requirements for fire prevention and safety in the workplace, its focus is primarily on protecting employees. This includes guidelines for fire extinguishers, fire prevention plans, and employee training.</li></ul></div><div><br></div><div><strong>Fire Safety - Compare and Contrast of Key Compliance Items:</strong></div><div><br></div><div><ul><li><strong>​Fire Prevention Plans:</strong></li><ul><li>​LSC: Emphasizes the importance of fire prevention in long term care facilities. This includes the development, implementation, and training of fire prevention plans, which outline measures to reduce the risk of fires. It addresses factors such as proper storage of flammable and combustible materials, maintenance of fire systems, and fire safety education for staff and residents.<br><br></li><li>OSHA: Requires workplaces, including health care settings, to have fire prevention plans (29 CFR 1910.39). These plans outline procedures for minimizing the risk of fires, including proper handling and storage of combustible materials, electrical safety measures, and employee training on fire prevention.</li></ul></ul></div><div><br></div><div><ul><li><strong>Emergency Evacuation Procedures:</strong><br></li><ul><li>​​LSC: Mandates the creation of emergency evacuation procedures, both internally and externally. These procedures ensure the safe and orderly evacuation of residents during a fire or other emergencies. This includes establishing clear exit routes, conducting regular drills, and providing training to staff and residents on evacuation protocols.<br><br></li><li>OSHA: Also requires workplaces to have emergency action plans (29 CFR 1910.38), which include procedures for evacuating employees during fires or other emergencies. These plans specify evacuation routes, procedures for reporting emergencies, and methods for accounting for all employees after evacuation.</li></ul></ul></div><div><br></div><div><ul><li><strong>​Fire Detection and Alarm Systems:</strong></li><ul><li>LSC: Sets standards for fire detection and alarm systems in long term care facilities. This includes requirements for the installation and maintenance of smoke detectors, fire alarms, and other fire detection devices to ensure timely notification of occupants in the event of a fire.<br><br></li><li>O<span style="font-size:11pt;">SHA: While OSHA does not have specific regulations regarding fire detection and alarm systems, it emphasizes the importance of early warning systems as part of overall emergency preparedness. Ensuring that employees are promptly alerted to the presence of a fire is crucial for a safe and effective response.</span></li></ul></ul></div><div><br></div><div><strong>Differences and Synergies:</strong></div><div><br>The CMS LSC and OSHA share common ground in their commitment to fire safety but differ in their specific approaches. Both emphasize the importance of fire prevention, emergency evacuation procedures, and the protection of occupants in long term care facilities. The LSC takes a comprehensive approach, covering various aspects of building safety, including fire detection systems, fire-resistant construction, and emergency egress.</div><div><br></div><div>OSHA, on the other hand, primarily focuses on safeguarding employees in the workplace, outlining fire safety measures such as fire prevention plans, emergency action plans, and the use of early warning systems. </div><div><br></div><div>While the LSC is more extensive in its coverage of fire safety within the context of overall building safety, OSHA's regulations provide specific guidelines tailored to the workplace, ensuring a safe environment for employees, and indirectly contributing to the overall well-being of facility occupants. Combining compliance with both sets of regulations is crucial for long term care facilities to establish a system framework for the safety of both residents and staff.</div><div><br></div><div><strong>Conclusion:</strong></div><div><br></div><div>In navigating safety regulations, long term care centers should consider both the CMS LSC and OSHA guidelines when implementing and training fire safety measures. This approach ensures compliance with standards for overall life safety, creating an environment where fire safety protocols are effectively designed, implemented, and maintained. Such adherence not only meets regulatory standards but also minimizes risks for employees and residents alike. AHCA/NCAL offers <a href="/Survey-Regulatory-Legal/Pages/Fire-Life-Safety.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">resources and education on life safety ​</a>on its website.<br></div>OSHA regulations and CMS’ Life Safety Code LSC have a common area of overlap with Fire Safety.