OSHA Compliance

Many chiropractors do not realize that they must comply with OSHA laws. Each office must have a written control plan. The extent that each office needs to be compliant depends on the number of employees an office has and the services each office provides.

In December 1970, the Occupational Safety and Health Act (OSHA) was signed into law, and its mission is to assure safe and healthful conditions for workers. In Illinois, Federal OSHA laws also cover private sector workers.

OSHA developed a set of guidelines and standards for physician offices. In this article, I am going to summarize these guidelines. The full text of OSHA standards can be found in Title 29 of the Code of Federal Regulations (29 CFR), at www.osha.gov, or by calling (800) 321-OSHA.

Bloodborne Pathogens Standard (29 CFR 1910.1030)

The bloodborne pathogens standards must be written and followed by all offices that have one or more employees. These standards are aimed at reducing occupational exposure to bloodborne diseases including but not limited to HIV, Hepatitis B and C. In 2000, Congress updated this rule when it passed the Needle Stick Safety and Prevention Act, which reduces the risk of needlestick and other sharp injuries. The basic requirements of the Blood Borne Pathogens Standard include:

1. A written exposure plan that is updated annually to eliminate or minimize exposures. This includes but is not limited to instructions on how to handle contaminated sharps. All sharps must be disposed of immediately in the proper sharps disposal containers. Contaminated sharps should never be broken or sheared. Contaminated sharps include any contaminated object that can puncture the skin including needles, broken glass, broken capillary tubes, etc.
2. The use of universal precautions when an employee comes into contact with human blood and other potentially infectious material (OPIM).
3. The use of safer engineered needles and sharps. Including sharp disposal containers, self-sheathing needles, etc.
4. The use of proper protective equipment (gloves, gowns, face and eye protection) – at no cost to the employee. Hand washing facilities with running water, soap, and single-use towels.
5. All regulated waste must be properly contained. Sharps disposal boxes, regulated waste containers, laundry bins for contaminated linens and specimen/transport containers that are labeled or color coded. Designated storage refrigerators and freezers must be labeled and used exclusively for blood or OPIM.
6. The Hepatitis B vaccine must be made available to any employee with occupational exposure to bloodborne pathogens within 10 days of initial assignment at no cost to the employee.
7. Post-Exposure evaluation and follow-up must be provided to any worker exposed to a bloodborne pathogen or OPIM at no cost to the employee.
8. All employees must be trained when hired and annually regarding all bloodborne and OPIM standards.

Small physician offices are currently exempt from maintaining an official log of reportable injuries and illnesses. All employers are required to report any work-related fatality or any single incident that results in 3 or more employees hospitalized.

Ionizing Radiation Standard (29 CFR 1910-1096)

This standard applies to facilities that have an x-ray machine. Radiation includes alpha rays, beta rays, gamma rays, x-rays, neutrons, high-speed electrons, high-speed protons, and other atomic particles. The following guidelines are required:

1. Restricted areas must be provided to limit employee exposure to radiation or radioactive materials. A restricted area is an area controlled by the employer for purposes of protecting individuals from exposure to radiation and radioactive materials.
2. Employees working in restricted areas must wear radiation monitors. These monitors measure the quarterly amount of radiation absorbed by an employee. For guidelines on dose, limitations go to OSHA.gov.
3. Rooms and equipment if needed should be labeled with caution signs.
4. A survey of the type of radiation must be completed.

Hazard Communication Standard (29 CFR 1910-1200)

This standard is also known as the “employee right to know” standard. The purpose of this section is to make sure that the hazards of all chemicals are classified by the manufacturer and that this information is made available to employers and employees. Employers are responsible for establishing a program to communicate this information to their workers. This includes:

1. A written hazard communication program
2. A list of hazardous chemicals. Hazardous chemical means any chemical classified as a physical hazard or health hazard. The criteria for determining whether a chemical is classified as a health hazard are detailed in Appendix A to 1910.1200 OSHA Health Hazard Criteria.
3. All containers containing hazardous chemicals in the workplace must be labeled, tagged or marked. Labels on chemicals cannot be removed or defaced and warnings must be legible, in English (or other languages when needed) and prominently displayed. For a list of exceptions go to OSHA’s web site.
4. A copy of Material Safety Data Sheets (MSDS) on each chemical used or stored in the office.
5. All employees must be trained on how to use hazardous chemicals and what to do if they are contaminated.

Electric Standards (29 CFR Subparts Electrical 1910.301 to 1910.399)

These standards address electrical safety requirements. This rule deals with the use and location of computers, faxes, copiers, refrigerators, microwaves, x-ray machines, etc. This article does not go into detail on this standard. For more information, read the full text at OSHA.com. Additionally, the ICS also advises our members to check with your liability insurance carrier and local fire department for their electrical guidelines.

Exit Route Standards (29 CFR Subpart E. 1910.35 to 1910.39)

This standard requires safe and accessible building exits in case of a fire or emergency. Most local fire and police have additional requirements.

1. An adequate number of exits for the number of employees.
2. Visibly posted evacuation route maps.

OSHA Poster (OSHA Pub. 3165) EVERY WORKPLACE MUST DISPLAY the OSHA POSTER

This poster must be posted where all employees can see it. This poster explains Worker rights to a safe workplace. How to file a complaint. An employee who makes a complaint cannot receive disciplinary actions or retaliation by his/her employer. You can download a free copy of the OSHA poster at www.osha.gov or call 1-800-321-OSHA.

As I stated earlier in the article, the extent that each office has to follow these guidelines depends on your specific office operations. Although most offices will never undergo an investigation by OSHA, most OSHA investigations result from a complaint by an employee. Inspections may result in a review of your written control plan or a site review. Monetary penalties for violations can result in the following: up to $7,000 for serious violations and up to $70,000 for repeat violations. OSHA.gov has an excellent outline for its Blood Borne Pathogens Standards and for its Hazard Communications Standards that can be used as templates for your own workplace. The full guidelines that I summarized in this article can be found on the OSHA website. It is not difficult to follow the standards that pertain to your office. Make sure your office is OSHA-compliant. It is the LAW.