Nursing Home eTool
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Common safety and health topics:
Safety and Health Programs
The nursing home industry injury and illness incident rate is 12.5 injuries and illnesses per 100 full-time workers. This is almost three times the incident rate of 4.2 of industry as a whole. TABLE 1. Incidence rates of nonfatal occupational injuries and illnesses by industry and case types, 2008. US Department of Labor (DOL), Bureau of Labor Statistics (BLS), (2009, October 10). Also available as a 115 KB PDF, 35 pages. (Search for Nursing and residential care facilities, NAICS 623)
||Exposure to unsafe workplaces due to an ineffective safety and health program.
OSHA has noted a strong correlation between effective safety and health programs and a low incidence of occupational injuries and illnesses. Therefore, it is recommended that facilities develop and manage a safety and health program appropriate for the potential hazards present at their site. The different modules of this eTool suggest specific topics to address. The main elements of a safety and health program include:
- Management Leadership and Employee Participation.
- Workplace Analysis.
- Accident and Record Analysis.
- Hazard Prevention and Control.
- Safety and Health Training.
- Regular Program Review.
Possible fire safety hazards from:
Employers must comply with OSHA Standards on Exit Routes, Emergency Action Plans, and Fire Prevention Plans, 29 CFR 1910 Subpart E, including:
Employers need to comply with OSHA Standard 29 CFR 1910.38, Emergency action plans, and 29 CFR 1910.39, Fire prevention plans. See Dietary Fire Safety for further discussion of OSHA requirements.
- The number of exit routes must be adequate [29 CFR 1910.36(b)].
- Two exit routes. At least two exit routes must be available in a workplace to permit prompt evacuation of employees and other building occupants during an emergency [29 CFR 1910.36(b)(1)].
- More than two exit routes. More than two exit routes must be available in a workplace if the number of employees, the size of the building, its occupancy, or the arrangement of the workplace is such that all employees would not be able to evacuate safely during an emergency [29 CFR 1910.36(b)(2)].
- A single exit route. A single exit route is permitted where the number of employees, the size of the building, its occupancy, or the arrangement of the workplace is such that all employees would be able to evacuate safely during an emergency [29 CFR 1910.36(b)(3)].
For assistance in determining the number of exit routes necessary for your workplace, consult National Fire Protection Association standard, NFPA 101-2009, Life Safety Code.
- Exit routes must be free and unobstructed. No materials or equipment may be placed, either permanently or temporarily, within the exit route. The exit access must not go through a room that can be locked, such as a bathroom, to reach an exit or exit discharge, nor may it lead into a dead-end corridor. Stairs or a ramp must be provided where the exit route is not substantially level [29 CFR 1910.37(a)(3)].
- Each exit must be clearly visible and marked by a sign reading "Exit" [29 CFR 1910.37(b)(2)].
Construction or Maintenance Operation Areas:
- Address emergency evacuation with special consideration to evacuating physically impaired patients.
- Review emergency evacuation plans with employees initially, or whenever their responsibilities or plan changes [29 CFR 1910.38(f)].
- Exit routes must be maintained during construction, repairs, or alterations. Any area under construction or under maintenance must:
- Not be occupied in whole or in part until all exits required for that part are completed and ready for use [29 CFR 1910.37(d)(1)].
- Continuously maintain existing exits and any existing fire protection, or other measures which provide equivalent safety [29 CFR 1910.37(d)(2)].
- Not expose employees to hazards of flammable or explosive substances or equipment used during construction, repairs, or alterations, that are beyond the normal permissible conditions in the workplace, or that would impede exiting the workplace [29 CFR 1910.37(d)(3)].
- Have travel from exits to outside continuously free and clear of obstruction. No materials or equipment may be placed, either permanently or temporarily, within the exit route [29 CFR 1910.37(a)(3)].
According to the OSH Act of 1970, "Each employer shall make, keep and preserve, and make available to the Secretary or the Secretary of Health, Education, and Welfare, such records regarding his activities relating to this Act as the Secretary, in cooperation with the Secretary of Health, Education, and Welfare, may prescribe by regulation as necessary or appropriate for the enforcement of this Act or for developing information regarding the causes and prevention of occupational accidents and illnesses." Section 8 (c)(1)
Employers not maintaining records that help:
- Document trends in illness and injury.
- Develop information regarding the causes and prevention of occupational accidents and illnesses.
Comply with OSHA Recordkeeping Standards:
The recordkeeping rule, 1904, Recording and reporting occupational injuries and illness, went into effect January 1, 2002.
- Frequently Asked Questions for OSHA’s Injury and Illness Recordkeeping Rule. OSHA. Additional guidance to help employers comply with the recordkeeping requirements. The following table of contents provides links to additional guidance, or, if additional guidance has not been developed, to the regulation.
- Injury & Illness Recordkeeping Forms. OSHA Forms 300, 300A, 301. Log of Work-Related Injuries and Illnesses has been revised. The forms, which are required for employers to use in recording injuries and illnesses, have changed in several important ways for 2004. The new forms must be in use by January 1, 2004.
- Recordkeeping Policies and Procedures Manual. OSHA Directive CPL 02-00-135, (2004, December 30).
- Highlights of OSHA's Recordkeeping Rule [64 KB PDF*, 2 pages]. OSHA Fact Sheet.
|Recordkeeping for Bloodborne Pathogens
Lack of information necessary to adequately implement Bloodborne Pathogens program and address Bloodborne Pathogen Hazards.
The Bloodborne Pathogens Standard [29 CFR 1910.1030], requires both medical and training records be maintained [29 CFR 1910.1020].
Medical Records must be preserved and maintained for each employee with occupational exposure to bloodborne pathogens [29 CFR 1910.1030(h)(1)].
Training Records: Employers must establish and maintain a training record for all exposed employees for 3 years, from the date the training occurred which includes [29 CFR 1910.1030(h)(2)]:
- For at least the duration of employment plus 30 years, and must be kept confidential (not disclosed without written permission of employee, except by law) and separate from other personnel records and must also include:
- The employee's name and social security number, hepatitis B vaccination status, including the dates of vaccination and medical records related to the employee's ability to receive vaccinations.
- If an exposure incident occurs, reports are added to the medical record to document the incident, including testing results following the incident, follow-up procedures, and the written opinion of the health care professional.
Revised Bloodborne Pathogens Standard: As mandated by the Needlestick Safety and Prevention Act, OSHA has revised its Bloodborne Pathogens Standard 29 CFR 1910.1030, effective date April 18, 2001. The Revised Exposure Control Plan requirements make clear that employers must implement the safer medical devices that are appropriate, commercially available, and effective [29 CFR 1910.1030(c)(1)(iv)(A)], and get input from those responsible for direct patient care in [29 CFR 1910.1030(c)(1)(v)]. The updated standard also requires employers to maintain a log of injuries from contaminated sharps [29 CFR 1910.1030(h)(5)].
- The names and job titles of all persons attending the training sessions, the dates, and content of the training sessions, and the trainer's name and qualifications.
- If the employer ceases to do business:
- Training and medical records must be transferred to the next employer or successor employer.
- If there is no successor employer, the employer must notify the Director of the National Institute for Occupational Safety and Health (NIOSH) for specific directions for the records at least 3 months prior to intended disposal.
- Both medical and training records must be available to [29 CFR 1910.1030(h)(3)(ii)]:
- Director of National Institute for Occupational Safety and Health (NIOSH).
- Assistant Secretary of Labor for Occupational Safety and Health.
- Employees or employee representatives (someone having written consent of the employee).
Employer and Employee Rights
Employers and employees are unable to participate effectively to assure a safe and healthful workplace.
- Employer Rights and Responsibilities Following an OSHA Inspection [537 KB PDF*, 28 pages]. OSHA Publication 3000-09R, (2011). Outlines employer rights and obligations following an inspection conducted under the Occupational Safety and Health Act of 1970.
- For additional information on employee and employer rights and responsibilities, see:
- For additional information on nursing homes, see:
- Administration on Aging. US Department of Health and Human Services (DHHS). For over 35 years, the Administration on Aging has provided home and community-based services to millions of older persons through the programs funded under the Older Americans Act-home-delivered meals programs or nutrition services in congregate settings, or transportation, adult day care, legal assistance or health promotion programs. If you have visited a nursing home, you may have talked to one of our Ombudsmen, who provide an on-going presence in long-term care facilities, monitoring care and conditions and providing a voice for those who are unable to speak for themselves. The National Family Caregiver Support Program provides a variety of services to help people who are caring for family members who are chronically ill or who have disabilities.
- Centers for Medicare and Medicaid Services (CMS)
- Medicare. People with Medicare, family members, and caregivers should visit Medicare.gov, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools.
- Medicaid. Title XIX of the Social Security Act is a Federal/State entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources.
- Guide to Choosing a Nursing Home [1 MB PDF, 72 pages]. Centers for Medicare & Medicaid Services (CMS), (2011, May). Assists in selecting the right nursing home facility.
- Nursing Home Overview. Centers for Medicare & Medicaid Services (CMS). Provides information on resident rights, and a nursing home checklist, which will help you evaluate the nursing homes that you visit.
Contaminated Work Surfaces
Exposure of employees to contaminated work surfaces at the nurses station from spilled lab samples such as blood or urine.
In order to prevent contact with blood or OPIM, workplaces must be kept clean and sanitary. Bloodborne Pathogens Standard [29 CFR 1910.1030(d)(4)(i)].
Accessibility Assistance: Contact the OSHA Directorate of Technical Support and Emergency Management at 202-693-2300 for assistance accessing PDF materials.
*These files are provided for downloading.