Summerlin Hospital cited by Nevada OSHA for multiple safety, health violations


Contact

Teri Williams
Public Information Officer
(702) 486-0407
Las Vegas, NV - April 10, 2014

Officials at Nevada OSHA have issued six serious and two other-than-serious citations after concluding an investigation into the tuberculosis outbreak that occurred at Summerlin Hospital in May 2013. Penalties for the eight violations cited totaled $39,600.   

  

The agency initiated an inspection after learning that at least two patients with unrecognized active tuberculosis (TB) were admitted into Summerlin Hospital Medical Center for treatment, one of which was admitted to the Neonatal Intensive Care Unity (NICU).  The infected patients received care by hospital staff, exposing the employees to Mycobacterium tuberculosis. Subsequently, at least 20 employees contracted TB and exhibited either active or latent forms of the infection.  

  

A comprehensive investigation of the incident was initiated to determine whether there was a violation of Nevada OSHA safety and health standards or the general duty clause, and any effect the violations had on the incident.  The investigation found multiple deficiencies in the hospital’s Tuberculosis Exposure Control Plan. 

 

SUMMARY OF CITED VIOLATIONS


1.      NRS 618.375(1), Serious citation- $6,300

a) At the time of inspection, Summerlin Hospital Medical Center’s most recent Tuberculosis (TB) Risk Assessment did not include statistical data related to a 2013 significant workplace exposure to Mycobacterium tuberculosis. A TB Risk Assessment that included this data is necessary in order to properly evaluate the quality of the hospital’s TB infection control plan, and identify any needed improvements in infection control measures. 

  

b) Since the recent workplace exposure to Mycobacterium tuberculosis, Summerlin Hospital Medical Center has not followed its own TB Exposure Control Plan that states a “Risk Evaluation” will be conducted in the event of an exposure. Prior to this inspection, Summerlin Hospital Medical Center did not conduct a Tuberculosis (TB) Risk Assessment that included statistical data related to a 2013 significant workplace exposure to Mycobacterium tuberculosis. 

  

2.      NRS 618.375(1), Serious citation-$6,300

a) At the time of inspection, Summerlin Hospital Medical Center’s Tuberculosis (TB) Exposure Control Plan had not been reevaluated since the occurrence of a significant workplace exposure to Mycobacterium tuberculosis. A reevaluation is needed to identify and correct possible problems in TB infection control. 

  

b) At the time of inspection, there was no requirement in Summerlin Hospital Medical Center’s Tuberculosis (TB) Exposure Control Plan for annual reevaluations, and the program was not reevaluated on an annual basis. A yearly reevaluation is needed to identify and correct possible problems in TB infection control. 

  

 3.      NRS 618.375(1), Serious citation- $6,300

At the time of inspection, Summerlin Hospital Medical Center did not have procedures in place to ensure that employees who have been directly exposed to patients with tuberculosis (TB) disease are screened for the infection as soon as possible after exposure to Mycobacterium tuberculosis, or are provided follow up screenings if needed. At least one hospital employee who had direct contact with at least one of the infected patients was not given an initial TB screening until eight weeks after the exposure. 

  

4.      NRS 618.375(1), Serious citation- $6,300

At the time of inspection, Summerlin Hospital Medical Center’s Tuberculosis (TB) Control Plan did not require prompt evaluations for all employees whose TB screening tests converted from negative to positive after exposure to tuberculosis. At least eight hospital employees who had converted as a result of this workplace exposure had to wait seven days or longer to receive a chest x-ray to rule out active tuberculosis. 

 

5.      NRS 618.375(1), Serious citation- $6,300

a) Summerlin Hospital Medical Center does not conduct proper diagnostic measures for patients who display signs of tuberculosis (TB). In 2013, at least two patients with unrecognized TB disease were admitted into the hospital and cared for by hospital staff, one of whom displayed signs of tuberculosis, presenting with miliary TB with pulmonary involvement, but a sputum examination was never conducted. Employees were exposed to Mycobacterium tuberculosis, subsequently causing at least 20 employees to contract tuberculosis and exhibit either active or latent forms of the infection. 

  

b) At the time of inspection, Summerlin Hospital Medical Center’s TB Exposure Control Plan did not include all the significant symptoms that are indicative of a tuberculosis diagnosis, nor did it require the administration of subsequent diagnostic measures, such as a sputum culture, in the presence of these symptoms.

   

6.      NRS 618.375(1), Serious citation- $6,300

a) Summerlin Hospital Medical Center did not initiate airborne precautions for patients who display signs of tuberculosis (TB). When a patient displayed signs of tuberculosis, presenting with miliary TB with pulmonary involvement, airborne precautions were never initiated.  

  

b) At the time of inspection, Summerlin Hospital Medical Center’s TB Exposure Control Plan did not require initiation of airborne precautions for all inpatients who exhibit signs or symptoms of tuberculosis (TB) disease. The plan only addressed the institution of airborne precautions for patients that are known or suspected in the Emergency Room and Admitting Area. The TB Exposure Control Plan also did not specify persons authorized to initiate and discontinue airborne precautions. 

  

7.      29 CFR 1904.11(a), Other-than-serious citation- $900

In 2013, 20 employees of Summerlin Hospital Medical Center converted to positive tuberculin skin tests (TST) and developed either active or latent forms of a tuberculosis (TB) infection after at least two patients with unrecognized TB disease were admitted into the hospital.  The employer did not record these 20 cases of occupational exposure to TB on its 2013 OSHA 300 logs, which were certified by the employer as true, accurate and complete on January 8, 2014. 

  

8.      29 CFR 1904.29(b)(7)(iv), Other-than-serious citation- $900

Summerlin Hospital Medical Center did not ensure that an employee who was potentially exposed to tuberculosis was entered on the OSHA 300 logs as a "privacy concern case.” Employee privacy was not protected and the employee’s full name was listed for Case #7161 on the 2013 OSHA 300 logs, which were certified by the employer as true, accurate and complete on January 8, 2014. 

 

The maximum penalty that can be assessed for a serious violation is $7,000. Penalty adjustment factors for employer size, gravity of the violation, good faith and history are considered. The $6,300 penalty assessed for the serious citations for Summerlin Hospital Medical Center takes into account a 10% reduction due to a clean inspection history with no violations cited in two previous inspections unrelated to the TB exposure.  

  

Summerlin Hospital Medical Center has 15 working days from the day the citation and proposed penalties were received to remedy the violation and pay the associated penalties or notify OSHA of their intent to contest the citation. Summerlin Hospital may also request an informal conference to be held within the 15 day period to receive further clarification or present additional evidence related to the violations cited, discuss options to correct the workplace hazards or enter into an informal settlement agreement.   

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