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The
following topics relate to occupational safety and health hazards in
maintenance:
Legionnaires'
Disease
Generally occurs where water is contaminated
with the legionella organism and is aerosolized and then breathed in
by workers or patients.
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Hazard
Exposure to the legionella organism and Legionnaires' Disease:
- Hazard of breathing contaminated, aerosolized
water could
occur in
areas where:
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Cooling towers, humidifiers and/or air conditioning
systems or domestic hot water systems are used.
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Spray nozzles are used:
kitchens, janitorial closets, showers.
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- Can cause a mild respiratory
illness (that may not require treatment) or severe pneumonia like
symptoms 2 to 10 days after exposure.
- If not detected and treated promptly
with appropriate antibiotics, can lead to death.
- Fatality rate is
approximately 15%.
Example
Controls
Good work practices found
in the OSHA Technical
Manual on Legionnaries' Disease include:
- Domestic hot-water systems
- Store Hot water at 140 degrees
F and delivered at a minimum of 50°C (122°F) to all outlets.
To avoid scalding problems
install fail-safe scald
protection equipment, such as preset
thermostatic mixing valves.
- Where building cannot be retrofitted, periodically
increasing the temperature to at least 158 degrees F or
chlorination followed by flushing should be considered.
- Systems should be inspected annually to ensure equipment is
functioning properly.
- Domestic cold-water
systems:
- Maintain cold-water
lines below 68 degrees F.
- Water tanks that allow
water to remain uncirculated for long periods should be
eliminated or designed to reduce storage time to a day or
less. They should also be covered and protected from
temperature extremes.
- Cross-contamination of
the domestic cold water system with other systems shall be
prevented.
- If the cold-water lines
have significant contamination, hyperchlorination can
eradicate legionella
- Cooling towers should be cleaned and disinfected at least twice
a year.
- Periodic use of biocides is recommended to control bacteria
growth.
- Provide visual inspection and periodic maintenance of the
system, to prevent buildup of scale and sediment and
bio-fouling, which
support legionella growth.
Legionnaires'
Disease Chapter 7 Section III, OSHA Technical Chapter, Controls,
Source
Identification.
- Appendix
III:7-5. OSHA Technical Chapter, Water Treatment Protocols
for Facilities that have experienced a Legionnaires' Outbreak.
- Appendix
III:7-1. Employee
Awareness Program, to inform employees of any potential outbreaks, and
to educate about the disease.
The CDC in Legionellosis:
Legionnaires' Disease and Pontiac Fever recommends to limit the
growth and spread of Legionella organisms by:
- Improving design and maintenance of cooling towers and plumbing
systems.
- Identifying the source of disease transmission and providing appropriate prevention and control measures, such as the
decontamination of the water source.
Medical
Awareness of Physicians and Health Care Workers (HCWs):
HCWs need to be aware that
the bacteria can be present in water systems and promptly test
vulnerable and/or symptomatic patients and use appropriate
antibiotics quickly.
- Legionnaires' Disease
most frequently attacks individuals who have an underlying
illness or weakened immune system. The most susceptible
include persons who are elderly, smokers, and immunosuppressed.
- Symptoms include:
dry cough, high fever, chills, muscle aches, diarrhea,
fatigue, headache, and abdominal pain.
- Usually treated with
erythromycin or a combination of erythromycin and Rifampin.
The Whirlpool/Shower
module also addresses
Legionnaires' Disease.
Additional Information
- In September of 1999, the Joint Commission on Accreditation of Healthcare
Organizations, (JCAHO) Committee on Healthcare Safety
recognized,
the need to emphasize and reduce
organizational acquired illness by updating the current Environment of Care Standards
which would include and address:
- Issues of improperly designed and maintained
aerosolizing water systems (controlling pathogenic
biological agents such as legionella in cooling towers,
domestic hot water systems, etc).
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Hazardous
Chemicals |
Hazard
Exposure to hazardous chemicals from cleaning and
maintenance work:
- The Hazard Communication
Standard is based on the concept that: Employees
have both a need and a right to know the hazards and the identities of
the chemicals they are exposed to when working, and what protective
measures are available or needed to prevent adverse effects from
occurring.
Example Controls
Implement
a written program which meets the requirements of the Hazard
Communication Standard (HCS) to provide for worker training,
warning labels, and access to Material Safety Data Sheets (MSDS).

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The
Hazard Communication Standard
ensures employee awareness of the hazardous chemicals they are
exposed to in the workplace.
- Agents with any of
the following characteristics are considered hazardous:
carcinogens, corrosives, toxic or highly toxic, irritants,
sensitizers, or target organ effectors Hazard
Communication Standard
Appendix
A and chemicals listed in 1910.1000 Table
2.
- Both human and animal
data are to be used in this determination. The Hazard
Communication Standard
Appendix
B lists sources of toxicity information.
-
There are exceptions
to some of the requirements of the HCS for consumer products that
are subjected to the
labeling requirements of the terms as defined in the
Consumer Product Safety Act and the Federal Hazardous
Substances Act [1910.1200(b)(5)(v)].
- For example, OSHA does not require
that MSDS be provided to purchasers of household consumer
products when the products are used in the workplace in the
same manner that a consumer would use them, i.e.; where the
duration and frequency of use (and therefore exposure) is
not greater than what the typical consumer would
experience. This exemption applies to many of the
cleaning products used in nursing homes.
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- All hazardous
chemicals such as those found in some soaps, disinfectants,
pesticides, must be clearly labeled as hazardous [1910.1200(f)].
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- Workers must be
trained in potential chemical hazards and controls
(engineering controls, work practices, PPE) necessary to
prevent hazards in the work area [1910.1200(h)(3)].
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- Provide PPE (e.g.,
gloves, goggles, splash aprons) as appropriate
when handling hazardous dishwashing detergents and
chemicals [1910.132].
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- Medical Services
and First Aid: Where the eyes or body of any person may be exposed to
injurious corrosive materials, suitable facilities for
quick drenching or flushing of the eyes and body shall be
provided within the work area for immediate emergency use
[1910.151(c)].
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- Switch to chemicals
and cleaning products that are non-hazardous.
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Other Recommended Good
Work Practices:
- Employers need to be aware that paints,
adhesives, solvents, and cleaners may give off toxic vapors,
and special ventilation
and air monitoring practices may be needed.
- Never mix ammonia and chlorine in a cleaning solution and
never pour both down a drain together. When mixed these chemical
form a deadly gas.
The Utility,
Dietary
and Laundry
modules also address Hazardous Chemicals.
Additional Information
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Fire
Safety
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Hazard
Potential
fire hazards:
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- Heat-producing equipment.
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- Storage of
flammable chemicals.
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Example Controls
OSHA requires:
- Keep grill, and grill duct
work clean of flammable residues and properly maintained [1910.38(b)(3)
and (5)].
- Flammable items must be
stored away from heat producing equipment [1910.38(b)(3)].
- A
facility's fire prevention plan must address whether employees are
to fight fires [1910.157]:
- If
employees are to fight fires, the employer must decide if
all employees or just designated employees will fight fires,
or if a fire brigade will be trained and equipped.
- If employees are not
to fight fires, (i.e., employer relies on safe evacuation
of all employees and outside services, e.g., local fire
stations to fight fires).
- Employers must
provide an Emergency Action Plan, 1910.38(a)
and a Fire Prevention Plan,1910.38(b)
following the requirements of 1910.38.
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Machine
Guarding |
Hazard
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Possible amputations, and strangulations from lack of machine guarding measures. |
Example Controls
According to OSHA
Machine Guarding Standard,
machine guarding must be provided to protect employees from
hazards [1910.212]:
- Machine guarding can be
accomplished through the positioning of hazards so they are
inaccessible to employees (i.e. provide barrier guards over
dangerous equipment to prevent hazards of strangulation or
amputations).
- Other methods of machine
guarding:
- Two-handed tripping
devices.
- Electronic safety
devices.
The Dietary
module also addresses Machine Guarding.
Additional Information
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Lockout/Tagout |
Hazard
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Employee injuries occurring
during servicing or maintenance of machines or equipment from the
unexpected release of hazardous energy. |
Example Controls
OSHA Lockout/Tagout Standard identifies procedures necessary to shut down and lock
out or tag out machines and equipment to prevent possible injury [1910.147].
- Before service or maintenance is performed on machines or
equipment, the machines or equipment must be turned off and
disconnected from the energy source, and the energy-isolating
device must be locked out.
- Service or maintenance tasks that expose workers to the unexpected
release of hazardous energy are covered under this standard.
Additional Information
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Electric
Shock or Electrocution
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Hazard

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Possible electric shock and
contact with electrical hazards from: |
- Maintenance equipment and machinery.
- Using damaged receptacles and connectors.
Example Controls
Comply with OSHA
Standard 1910
Subpart S-Electrical-General. The standard is comprehensive
and includes the following sections:
- Electrical
equipment shall be free from recognized hazards [1910.303(b)(1)].
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Listed
or labeled equipment shall be used or installed in
accordance with any instructions included in the listing
or labeling [1910.303(b)(2)].
-
Sufficient
access and working space shall be provided and maintained
around all electric equipment to permit ready and safe
operation and maintenance of such equipment [1910.303(g)(1)].
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Ensure
that all electrical service near sources of water is
properly grounded [1910.304(f)(5)(v)].
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Tag
out and remove from service all damaged receptacles and
portable electrical equipment [1910.334(a)(2)(ii)].
- Repair all damaged
receptacles and portable electrical equipment before
placing them back into service[1910.334(a)(2)(ii)].
- Ensure that
employees are trained not to plug or unplug energized
equipment when their hands are wet [1910.334(a)(5)(i)].
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Safeguards
for personnel protection. Electrical protective equipment [1910.335].
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Selection
and use of work practices [1910.333].
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Hazardous
Classified Locations [1910.307].
The Dietary
module also addresses Electric Shock.
Additional Information
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Mercury Spills
Acute exposure: Acute
inhalation of mercury vapor may result in toxicity similar to metal
fume fever including chills, nausea, general malaise, tightness in the
chest, chest pains, dyspnea, cough, stomatitis, gingivitis,
salivation, and diarrhea [ACGIH 1991; Hathaway et al. 1991].
Chronic exposure:
Chronic exposure to mercury may result in weakness, fatigue, anorexia,
weight loss, and disturbance of gastrointestinal function.
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Hazard
Exposure to mercury from accidental spills
that can occur during repair of broken thermometers,
sphygmomanometers, barometers, gauges, and
valves or during sterilization and centrifugation of thermometers in
maintenance areas. Exposure to mercury occurs through inhalation or through
skin contact. If spills are not promptly cleaned up, mercury may accumulate
on surfaces and then vaporize and be inhaled by unaware
workers. Short exposure to high levels of mercury can produce severe
respiratory irritation, digestive disturbances and marked renal
damage.
Example Controls
Safety and health program that provides for prompt, safe, clean-up
of spills by workers trained in proper procedures.
OSHA requires:
- Exposure to mercury vapor shall not exceed an 8-hour
time-weighted average limit of 1 mg/10 M3 (0.1 mg/M3) [1910.1000].
- Employers must select
and provide appropriate PPE for clean up of spills[1910.134]
and [1910.132].
- It is mandatory that no
employee be allowed to consume food or beverages in an area
exposed to mercury [1910.141(g)(2)].
NIOSH
recommends:
- Clean-up spills promptly with special mercury vacuum
cleaners and a water-soluble mercury decontaminant.
- Use disposable protective equipment, protective gloves,
special mercury vapor respirators, and gowns, and hoods while
cleaning up mercury spills.
- Disposal according to US EPA regulations. (40
CFR 261.24).
- Avoid carpeting or porous surfaces on floors that would make
clean-up difficult.
- All spill areas are to be clearly posted until adequate
clean-up has been accomplished.
- Medical monitoring should occur for the respiratory track,
nervous system, kidneys, and skin of any worker who may be
exposed to mercury.
Good Work Practice
recommends:
- Prevent the spill in
the first place by replacing outdated glass thermometers, and
sphygmomanometers.
- Have spill kits
available to help clean up small spills of 25 ml or
less.
- Procedures in place
that allow for isolation of the contaminated area.
- Use a Mercury Vapor
Analyzer (Jerome) to verify that the area is safe to reenter.
For more information see OSHA's
Standard for Mercury, 1910.1000, Air Contaminants table
Z-2.
Additional Information
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Asbestos Exposure
Asbestos is a widely used, mineral-based material that is
resistant to heat and corrosive chemicals. Typically, asbestos appears as a
whitish, fibrous material which may release fibers that range in texture from
coarse to silky; however, airborne fibers that can cause health damage may be
too small to see with the naked eye.
Inhaling these airborne asbestos fibers can cause
asbestosis (scarring of the lungs resulting in loss of lung function
that often progresses to disability and to death); mesothelioma
(cancer affecting the membranes lining of the lungs and abdomen);
lung cancer; and cancers of the esophagus, stomach, colon, and
rectum.
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Hazard
Maintenance workers can be exposed to asbestos from many possible
areas and sources. It is often associated with boilers and piping
systems or working in areas or with items that might not be expected
to contain asbestos.
Asbestos is more commonly found in buildings built in the1940's
and 1950's, and can be found in many items, such as:
- HVAC Duct Insulation
- boiler insulation
- pipe insulation
- cooling towers
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- floor tile/ceiling tile
- electrical wiring insulation
- wall board or spackling
compounds
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Example Controls
A safety and health program
that educates, and protects employees
from the hazards of asbestos exposure in the workplace.
Permissible exposure limits
(PELs) to Asbestos are set by
OSHA:
-
Asbestos Standard for General Industry [1910.1001]:
- Sets a maximum exposure limit and include provisions for
engineering controls and respirators, protective clothing,
exposure monitoring, hygiene facilities and practices,
warning signs, labeling, recordkeeping, and medical exams.
- Workplace exposure is limited to 0.1 fibers per cubic
centimeter of air (0.1 f/cc), averaged over an eight-hour
work shift. The excursion or short-term limit is one fiber
per cubic centimeter of air (1 f/cc) averaged over a
sampling period of 30 minutes.
- Significant
Changes in the Asbestos Standard for General Industry, 1910.1001
(through June 29, 1995). Office of Training and Education,
training materials.
- The PEL was reduced from 0.2 fibers/cc to 0.1 fibers/cc from
0.2 fibers/cc as a TWA. The Excursion Limit remains 1.0
fibers/cc averaged over 30 minutes.
- Asphalt and vinyl flooring material installed
before 1980 also must be treated as asbestos-containing.
- Installed thermal system insulation and sprayed-on and troweled-on surfacing materials found in buildings constructed
no later than 1980 are presumed to be asbestos-containing
materials (greater than 1% asbestos).
- Sanding of asbestos-containing flooring material is
prohibited.
- Building and facility owners must determine the presence,
location, and quantity of asbestos-containing material (ACM)
and presumed asbestos-containing material (PACM) and keep
records of ACM/PACM.
- Building and
facility owners must inform other employers, and their own employees
who will perform housekeeping activities, of the presence and
location of such materials.
- Employers must provide an asbestos awareness training course
to employees who will perform housekeeping activities in an
area containing ACM or PACM.
EPA regulations (40 CFR), PDF
files or text.
The TSCA Asbestos regulations are found in 40
CFR 763.
Additional Information
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