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OSHA Publishes Final Rule on Hearing Loss
Removal of Contaminated Needles Clarified
Potassium Iodide as a Thyroid Blocking Agent
Disabled People Cannot Demand Jobs that Endanger Them
Arthroscopic Surgery for Osteoarthritis of the Knee
UCLA Launches Interactive Needlestick Web Site
New National Emphasis Program Established
JCAHO Announces National Patient Safety Goals
Risk for Developing Carpal Tunnel Syndrome May Be Genetic
OSHA Publishes Final Rule on Hearing Loss
On July 1st OSHA published its Final Rule on Recording
Hearing Loss in the Federal Register. This is a revision of a portion of the Occupational Injury and
Illness Recording and Reporting Requirements rule published January 19, 2001. It is scheduled to take
effect on January 1, 2003.
Under the new rule employers are required to record 10 dB shifts in hearing acuity from the
employee’s initial hearing test when such shifts also result in an overall hearing level of 25
dB above audiometric zero, averaged over the frequency at 2000, 3000, and 4000 Hz. The old criteria
recorded 25 dB shifts. Read more at www.osha.gov/media/oshnews/june02.
[Comment: If your clinic performs audiology services
for industry, you must change what you do on January 1, 2003. This calculation change actually
simplifies things. No longer will you have to keep two sets of baseline audiograms—one for
threshold shifts and another for OSHA reportables. Under the new regulation, there is only the
threshold shift; it becomes OSHA recordable if the hearing levels at 2000, 3000, 4000 average 25 or
greater. If you are using software to analyze your audiograms, make sure you get an upgrade before
January 1, 2003. – William L. Newkirk, MD, FACPM (wln)]
[Editor’s Note: SYSTOC’s audiometric
component will be compliant with these changes by January 2003.]
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Removal of Contaminated Needles Clarified
OSHA released a letter of interpretation clarifying that
the bloodborne pathogen standard requires blood tube holders with needles attached to be immediately
discarded into a sharps container after the device’s safety feature is activated. The agency
outlined its contaminated needle policy, explaining that it is rarely, if ever, required by a medical
procedure to remove a needle from a used blood-drawing/phlebotomy device. Read more at www.osha.gov/media/oshnews/june02.
Potassium Iodide as a Thyroid Blocking Agent
A guidance document on Potassium Iodide as a Thyroid
Blocking Agent in Radiation Emergencies issued by the U.S. Department of Health and Human Services
Food and Drug Administration Center is available for review on-line. The objective of the document is
to provide guidance to other federal, state, and local agencies regarding the safe and effective use
of KI as an adjunct to other public health efforts in the event that radioactive iodine is released
into the environment. Read more at www.fda.gov/cder/guidance/4825fnl.htm.
Disabled People Cannot Demand Jobs that Endanger
Them
On June 10th the United States Supreme Court ruled that
disabled people cannot demand jobs that would threaten their lives or health. Justice Souter,
expressing the unanimous opinion of the court, wrote: “A regulation of the Equal Employment
Opportunity Commission authorizes refusal to hire an individual because his performance on the job
would endanger his own health, owing to a disability. The question in this case is whether the
Americans with Disabilities Act of 1990…permits the regulation. We hold that it does.”
The Chevron v. Echazabal case brings into sharp focus a little-discussed inconsistency in the
crafting and implementation of the Americans with Disabilities Act (ADA). ADA allows the denial of
employment if employment would create a “direct threat,” which is defined as a
“direct threat to the health or safety of other individuals in the workplace.” In
implementing the Act, the Equal Employment Opportunity Commission (EEOC) expanded the definition
beyond that passed by Congress to “a significant risk of substantial harm to the health or
safety of the individual or others” Obviously, this expansion makes a huge difference.
Congress’s formulation does not allow the consideration of potential health risks on the
individual in hiring decision, only whether the employee can perform the essential job functions.
Congress specifically rejected a broader approach. The EEOC nonetheless implemented a broader
definition setting up the conflict and the basis for this case. The court sided with the EEOC. This
case is one of a series of rulings that have progressively narrowed the scope of ADA.
[Comment: This decision increases the value of pre-placement screening because the Supreme Court
has now unequivocally stated that prospective employees can be rejected if a job threatens the
prospective worker’s health or safety. Whether this has been permissible has been in debate
since the ADA was passed. It is debatable no longer. – wln]
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Arthroscopic Surgery for
Osteoarthritis of the Knee
In the July 11th issue of the New England Journal
of Medicine, J. Bruce Mosely and his colleagues from the Houston Veterans Affairs Medical Center
report the results of a sophisticated, randomized control trial evaluating the effectiveness of
arthroscopic surgery for the treatment of osteoarthritis of the knee. The study, entitled “A
Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee,” evaluated 180
patients with osteoarthritis of the knee who were randomly assigned to receive arthroscopic
debridement, arthroscopic lavage, or placebo surgery. The study went so far as to provide the
patients in the placebo group with skin incisions and a simulated debridement without insertion of
the arthroscope. The study found that at no point did the intervention groups report less pain or
better function than the placebo group.
[Comment: This elegantly designed study convincingly demonstrates the lack
of effectiveness of arthroscopic lavage and debridement for osteoarthritis of the knee. If you are
seeing patients with knee pain due to osteoarthritis, you should alter your treatment advice
accordingly. – wln]
UCLA Launches Interactive
Needlestick Web Site
In an effort to help doctors, nurses, and other
healthcare professionals make decisions about managing occupational exposure to patient body fluids,
an interactive web site named Needlestick is now available. It functions like a smart medical record,
guiding the healthcare provider in acquiring relevant data and selecting appropriate laboratory tests
and treatments. When completed, the healthcare provider may print specific after-care instructions.
Each case is managed anonymously, as the site does not collect any identifying data on the exposed
individual or the source of the body fluid. Read more at www.needlestick.mednet.ucla.edu.
New National Emphasis Program
Established
On July 15th OSHA announced a new National Emphasis
Program (NEP) to focus outreach efforts and inspections on specific hazards in nursing and personal
care facilities with reported high injury and illness rates. According to OSHA Administrator John
Henshaw, “The industry also ranks among the highest in terms of injuries and illnesses, with
rates about 2½ times that of all other general industries. By focusing on specific hazards
associated with nursing and personal care facilities, we can bring those rates down.”
The program focuses outreach efforts and inspections primarily on ergonomics related to resident
handling, exposure to blood and other potentially infectious materials, exposure to tuberculosis, and
slips, trips, and falls.
The National Emphasis Program will focus on those employers that have 14 or more injuries or
illnesses resulting in lost-work days or restricted activity for every 100 full-time workers. OSHA
plans to inspect 1,000 of these facilities. Read more at www.osha.gov/media/oshnews/july02/trade-20020715.html.
JCAHO Announces National Patient
Safety Goals
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) recently announced six national patient safety goals on which it will begin to
score healthcare organizations for compliance beginning January 1, 2003. The goals are:
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improve the accuracy of patient identification;
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improve the effectiveness of communication among
caregivers;
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improve the safety of high-alert medication;
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eliminate wrong-site, wrong-patient and wrong-procedure
surgery;
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improve the safety of infusion pumps;
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improve the effectiveness of clinical alarm
systems.
Read more at www.jcaho.org/news+room/news+release+archives/npsg.htm.
Risk for Developing Carpal Tunnel
Syndrome May Be Genetic
In the June 2002 issue of Arthritis and Rheumatism, Dr.
Alan J. Hakim and colleagues looked for the presence of carpal tunnel syndrome (CTS) in a population
of 4,488 females, comprising 867 pairs of monozygotic (MZ or identical) twins, 970 pairs of
dyzygotic (DZ or fraternal) twins, and 814 singletons. The study found an overall prevalence of
carpal tunnel syndrome in the population of 14.2%. The study found that the concordance for CTS was
significantly higher in MZ compared with DZ twins. The study estimated that the heritability for CTS
was 46% [95% Confidence Interval (CI) 34%-58%] that was essentially unchanged after adjustment for
environmental risk factors including age, body mass index, physical activities, and
hormonal/reproductive factors.
The study concluded: “Our data show that up to half
of the liability to CTS in women is genetically determined, and this appears to be the single
strongest risk factor, with only minor contributions from known environmental factors.”
[Comment: This is a very important study. Although it
is often repeated that carpal tunnel syndrome is caused by work or environmental factors, studies
thus far have been unable to confirm it. Until this study, much of the reason why some people get
carpal tunnel syndrome and others don’t has been unknown. This study is valuable in that it
demonstrates rather convincingly that about half of the risk for getting CTS is genetic. –
wln]
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