Meet the safety regulators.

Excerpted from Keeping the Long-Term Care Workplace Safe: How to Identify and Correct Environmental Hazards, by Dianne J. De La Mare and Michael J. Underwood, for the American Association of Homes and Services for the Aging

Are All Providers Subject to OSHA Requirements?

All providers in the private sector that employ at least one person are subject to OSHA requirements. There are no exemptions for nonprofit businesses. Government-owned and -operated facilities should check the laws in their states. Federal OSHA requirements do not apply in the public sector; however, many states have laws or executive orders that impose Federal OSHA requirements on government employers. Also, in states with their own plans, the state enforcement scheme extends to the public sector.

Are All of OSHA's Rules Mandatory ?

OSHA issues specific safety and health standards that are mandatory for all covered providers. OSHA also enforces a "general duty" clause that requires providers to keep facilities safe from "recognized hazards," even if there is no specific OSHA standard for that hazard.

In some cases, OSHA has issued guidelines for how to protect against certain hazards that are not covered by a specific standard. A recent example is the OSHA Guidelines for Preventing Workplace Violence Among Health Care & Social Service Workers. Although the guidelines are not mandatory, OSHA takes the position that workplace violence is a recognized hazard in health care and related industries.

OSHA will issue citations under the general duty clause if providers do not take responsible steps to address the hazard. OSHA considers following its guidelines to be "reasonable steps." Therefore, although OSHA guidelines are not "mandatory," providers should be familiar with them and use them in developing safety and health programs.

What Are the OSHA Requirements Most Likely to Apply to Long- Term Care Facilities?

The topics include:

* inspections;

* recordkeeping;

* workplace violence;

* developing safety and health programs;

* accidents and emergencies;

* hazard communication;

* bloodborne pathogens;

* asbestos;

* tuberculosis and respiratory protection;

* ergonomics; and

* lock-out/tag-out procedures for equipment.

Does NIOSH Play Any Role in OSHA Requirements or Inspections?

Congress created the National Institute for Occupational Safety and Health (NIOSH) under the Occupational Safety and Health Act of 1970. This law authorizes NIOSH to:

* investigate potentially hazardous working conditions;

* evaluate hazards in the workplace;

* create and disseminate methods for preventing disease, injury and disability;

* conduct research and provide scientifically valid recommendations for protecting workers; and

* provide education and training to individuals preparing for or actively working in the field of occupational safety and health.

What is CDC?

The Centers for Disease Control and Prevention is a Federal agency, operating within the U.S. Department of Health and Human Services, responsible for protecting the health of the general public and responding to public health emergencies. NIOSH is part of CDC and is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. CDC does not have any enforcement power and cannot conduct investigations or issue citations or penalties.

Are CDC Recommendations or Guidelines Mandatory?

CDC recommendations and guidelines relating to safety and health are not mandatory because the agency does not have any enforcement power. But state and federal agencies often view CDC recommendations and guidelines as indicating good standards of practice. CDC's recommendations sometimes are used by HCFA surveyors as standards of practice, and OSHA often relies on CDC guidelines to develop its own guidelines. Therefore, it is sound practice to be aware of CDC guidelines and use them as models for developing safety and health policies.

Which CDC Recommendations and Guidelines Most Likely Apply to Long-Term Care Facilities?

Providers should be aware of CDC recommendations concerning: * workplace violence;

* developing safety and health programs;

* bloodborne pathogens;

* ergonomics; and

* tuberculosis and respiratory protection.

CDC recommendations and guidelines become particularly important to long-term care providers when no OSHA regulation or standard exists. For example, OSHA has issued neither an ergonomics nor a tuberculosis standard but has made it clear that it believes these are recognized hazards in the industry. OSHA will enforce penalties against long-term care providers who do not comply with CDC recommendations and guidelines in those areas. OSHA has issued a compliance directive to OSHA Inspectors regarding tuberculosis that mirrors CDC's 1994 Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Facilities. OSHA has also given NIOSH exclusive authority to test and certify respirators for protection against tuberculosis in long-term care facilities.

CDC recommendations also influence the enforcement of OSHA standards. For example, OSHA takes the position that its bloodborne pathogen standard is updated automatically any time CDC makes new recommendations concerning bloodborne pathogens.

Which HCFA Requirements Most Likely Apply to Long-Term Care Facilities?

Providers must comply with all safety and health regulations developed by HCFA concerning:

* inspections;

* recordkeeping;

* workplace violence;

* developing safety and health programs;

* accidents and emergencies;

* bloodborne pathogens; and

* tuberculosis and respiratory protection.

HCFA requirements frequently overlap with OSHA requirements. Also, in some ways, HCFA requirements for resident care may seem conflicting with OSHA requirements for employee safety. Providers have the difficult task of balancing employee safety and resident care and services.

Are EPA Requirements Mandatory?

Environmental Protection Administration (EPA) requirements apply to groups such as manufacturers, architects, engineers, builders, building owners and managers, and building occupants, including long-term care providers. Providers must comply with all of the applicable safety and health regulations and standards. Like OSHA, EPA also writes "guidelines" that are not mandatory, but which providers should be familiar with and use as guides in developing policies.

Which EPA Requirements Most Likely Apply to Long-Term Care Facilities?

Providers must comply with all safety and health regulations developed by EPA concerning:

* inspections; and

* asbestos.

Providers who plan to demolish or renovate buildings and who, in doing so, may remove or disturb asbestos may have to notify certain state and local agencies or EPA before any activity begins.

Are FDA Requirements Mandatory?

Hospitals, ambulatory surgical facilities, nursing homes, outpatient treatment facilities and outpatient diagnostic facilities other than physicians' offices, including long-term care providers, must comply with the applicable safety and health Food and Drug Administration (FDA) regulations.

Which FDA Requirements Most Likely Apply to Long-Term Care Facilities?

Providers must comply with all safety and health regulations developed by FDA concerning:

* inspections; and

* recordkeeping.

Providers are identified as "user facilities" and must comply with all regulations developed by FDA concerning medical devices in the facilities. Providers must accurately identify and report any medical device problems to the FDA or the manufacturer that resulted or contributed to the serious injury or death of a resident. Providers must maintain the appropriate records concerning these types of incidents.