Inspections in Healthcare Facilities by the Ministry of Labour Presented to the WSIB Safety Group Sponsored by the Ontario Safety Association for Community and Healthcare (OSACH) February 28, 2008 Leonard Kuehner, M.Sc. Provincial Specialist

Disclaimer The material in this presentation is being provided as information only. Reference should always be made to the Occupational Health and Safety Act and the regulations to ascertain one's rights and duties under the law. It is the responsibility of all workplace parties to ensure compliance with the OHSA and the regulations and to seek independent legal advice where questions remain.

Outline Elements of an Inspection in a Healthcare facility Administrative Review A sample of the elements reviewed: Infection Prevention and Control Pandemic Influenza Planning Workplace Violence Prevention Ergonomic Issues Needle Safety Physical Inspection Enforcement After the Inspection

The Ministry of Labour’s Role in Occupational Health and Safety Set, communicate and enforce the Occupational Health and Safety Act (the “Act”) and associated regulations. 4 Programs: - Industrial - 28 sectors (Healthcare) - Construction - Diving - Mining

Role of the MOL Inspector Enforcement of the Act and related regulations Conduct: Proactive inspections Reactive investigations Sanctions and Recommendation of prosecutions under the Act for contraventions

Process for Inspections Unannounced/unscheduled Components: Administrative review Consultation with workplace parties, worker health and safety representative, Joint Health and Safety Committee Physical inspection of the workplace Preparation and delivery of inspection findings in field visit report(s) Sections: Orders where there is a contravention with the legislation (Notice of Compliance Form issued) Narrative (commentary)

Administrative Review Internal Responsibility System – members, minutes, issues, monthly inspections Copy of the Act and current Policy posted Effective Programs and training, maintenance MSDS and WHMIS training Infection Prevention and Control Programs Pandemic Planning and Response Safety Engineered Medical Devices (SEMDs) Workplace Violence Prevention Programs and Training Musculoskeletal Disorders (MSDs)/Ergonomic Injuries - review of From 7s, recurring injuries, issues, actions to address issues

Infection Prevention and Control: Written measures and procedures, developed in consultation with JHSC Annually reviewed (or when new information available, for example MOHLTC Important Health Notices (IHNs)) Risk assessment to identify risk of exposure to blood, body fluids, infectious diseases or sharps injury

Infection Prevention and Control: Implement control measures to reduce risk Training and education of staff Use of personal protective equipment Reporting of occupational illnesses under s.52(2) of the Occupational Health and Safety Act

Pandemic Influenza Planning: Regulation for Healthcare and Residential Facilities requires employers to have written measures and procedures for the control of infections Written procedures dealing with Health and Safety of workers in the event of pandemic influenza Consultation with the Joint Health and Safety Committee required Worker training Personal protective equipment Training, proper use and maintenance, proper fit

Workplace Violence Prevention Under the Occupational Health and Safety Act, all employers must take every precaution reasonable in the circumstances to protect the health and safety of their workers in the workplace. This includes protecting them against the risk of workplace violence.

Workplace Violence Prevention Greater potential of risk of workplace violence in healthcare settings Issue order for risk assessment where appropriate Where risk assessment reveals a hazard, the employer is to establish and implement written measures and procedures for a violence prevention program, developed in consultation with JHSC Annually reviewed (or when new information available) Worker training

Ergonomic Injuries/MSD Initiative Half of all work days lost are due to ergonomics-related injuries Inspectors focus on workplace MSD at high-risk workplaces Where appropriate, require employers to conduct risk assessments and implement programs where MSDs are prevalent.

Needle Safety Regulation (O. Reg. 474/07) Comes into effect September 1, 2008 Applies to acute care facilities in Ontario. It will mandate the use of safety-engineered hollow-bore needles and needle-less devices in hospitals. Proposed amendment in the future that extends the requirements to other health care workplaces such as long term care homes Currently, where a safety-engineered needle would be a reasonable precaution to protect a worker, an employer is required to provide for its use

Physical Inspection A walk through random areas of the facility Physical hazards, such as slips/trips/falls, machine guarding, lock-out, storage of materials, lift devices Personal Protective Equipment - eye, foot, skin, respirator, etc WHMIS (Workplace Hazardous Material Information System) – labels, Material Safety Data Sheets (MSDSs) and worker education Designated Substances

Enforcement Tools for Contraventions Progressive Enforcement Orders Part I Offence Notice and Summons Part III Summons

Enforcement Tools: Orders Time-based (deadline) Requirement (deadline) Forthwith (complied with at the time of the field visit) Compliance plan (deadline) Stop work (effective immediately, no deadline)

Enforcement Tools - no prison time Part I Offence Notice – schedule of offences Part I Summons – court appearance with maximum fine of $500 - no prison time Part III Summons Individual - court appearance with maximum fine of $25,000 per count and/or up to twelve months imprisonment Corporation - court appearance with maximum fine of $500,000 per count

After the Inspection When the Inspector conducts the inspection and delivers the field visit report of the findings, ask questions. If uncertain about how to comply with an Inspector’s order, the employer may wish to contact a Health and Safety Association for assistance or contact the MOL Inspector for further explanation.

After the Inspection If a delay is anticipated in complying with an Inspector’s order - inform the MOL Inspector immediately. If there is disagreement with an Inspector’s order, there is a 30-day time period (from the date the order was issued) during which to file an appeal of the order with the Ontario Labour Relations Board (OLRB). For information about their firm’s Illness and Injury rates, a business should contact their WSIB Client Service Representative.

Questions?

Explanation of Orders: The employer shall take every precaution reasonable in the circumstances for the protection of a worker. An employer shall ensure that the equipment, materials and protective devices provided by the employer are maintained in good condition. OHSA s.25(2)(h) OHSA s.25(1)(b)

Explanation of Orders: O.Reg. 67/93 s.9(1) The employer shall reduce the measures and procedures for the health and safety of workers established under section 8 to writing and such measures and procedures may deal with, but are not limited to, the following: 1. Safe work practices. 2. Safe working conditions. 3. Proper hygiene practices and the use of hygiene facilities. 4. The control of infections. 5. Immunization and inoculation against infectious diseases. 6. The use of appropriate antiseptics, disinfectants and decontaminants. 7. The hazards of biological, chemical and physical agents present in the workplace, including the hazards of dispensing or administering such agents. 8. Measures to protect workers from exposure to a biological, chemical or physical agent that is or may be a hazard to the reproductive capacity of a worker, the pregnancy of a worker or the nursing of a child of a worker. 9. The proper use, maintenance and operation of equipment. 10. The reporting of unsafe or defective devices, equipment or work surfaces. 11. The purchasing of equipment that is properly designed and constructed. 12. The use, wearing and care of personal protective equipment and its limitations. 13. The handling, cleaning and disposal of soiled linen, sharp objects and waste.

Explanation of Orders: O.Reg. 67/93 s.70(1) O.Reg. 67/93 s.9(4) O.Reg. 860/90 s.17(3) When used outdoors or in wet locations, portable electrical tools shall be protected by a ground fault circuit interrupter installed at the receptacle or on the circuit at the electrical panel. The employer, in consultation with and in consideration of the recommendation of the joint health and safety committee or health and safety representative, if any, shall develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to the workers' work. When a supplier material safety data sheet is 3 years old, the employer shall, if possible, obtain from the supplier an unexpired supplier material safety data sheet if any of the controlled product remains in the workplace.

Explanation of Orders: OHSA s.25(2)(a) OHSA s.25(2)(j) O.Reg. 67/93 s.9(2) OHSA s.57(4) Without limiting the strict duty imposed by subsection (1), an employer shall provide information, instruction and supervision to a worker to protect the health or safety of the worker. The employer shall prepare and review at least annually a written occupational health and safety policy and develop and maintain a program to implement that policy. At least once a year the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice. An order made under subsection (1) may require a constructor, a licensee or an employer to submit to the Ministry a compliance plan prepared in the manner and including such items as required by the order.

Additional sources of material http://www.health.gov.on.ca/english/providers/program/infectious/pidac/pidac_mn.html http://www.health.gov.on.ca/english/providers/program/emu/pan_flu/pan_flu_plan.html