OSHA HIPAA By Elizabeth Cummings RN BSN MSNED
OSHA & HIPAA By: Elizabeth Cummings RN, BSN, MSN-ED.
OSHA O Occupational Safety and Health Administration (OSHA) O Part of the Department of Labor O Two main standards O Occupational exposure to Hazardous Chemicals Standard O Blood Borne Pathogen Standard
OSHA Standards O Occupational Safety and Health Act of 1970 O Passed to keep workers safe and free from harm O Workplace safety O Health standards Has been amended several times
Responsibilities of Employers O Must follow all OSHA safety and health O O O O standards Must correct any breech of standards Must provide on-going training about OSHA and health standards Notify OSHA if major event occurs Provide PPE free to employees Keep record of all work related injuries Post OSHA citations Do not retaliate or discriminate toward workers exercising their rights
Employee Rights O Safe working environment O Information and training O Review work related material/records/test results/surveys O File complaints with OSHA O Not be discriminated or retaliated against for exercising rights
Question #1 O Employees have the right to work in what type of environment A. A safe working environment B. An environment that is adapted around his/her needs C. An environment where education is offered only at the time of hiring D. All the above
Department of Labor States… O More individuals are hurt or become sick than any other industry! O Potential Hazards O Bloodborne pathogens O Chemical/drug exposure O Ergonomic complications O Workplace violence O Radioactivity
Safety of Health Care Workers O Exposure Incident: exposed to both hazardous materials and health hazardous conditions such as other potentially infectious materials (OPIM) in relation to performing job duties O Health care workers must be protected because of the expectation that they will come into contact with blood and OPIM
Employer Responsibility O Written exposure control plan O To minimize or eliminate exposure to blood borne pathogens and/or OPIM O Update plan annually O To comply with new regulations and technologies O Require use of universal precautions O Treating all OPIM (other potentially infectious materials) and blood borne pathogens as infectious
CONT. O Engineering controls for transport of blood- borne pathogens and hazardous waste from the facility O Sharps containers, biohazard bags, etc… O Policies and procedures to ensure a safe working environment O Audit the performance of tasks and make necessary changes to minimize or eliminate exposure O Provide personal protective equipment (PPE) O All safety equipment (gowns, gloves, masks, etc. . ) will be provided to all employees free of charge
CONT. O Make Hepatitis B vaccination available to all workers O Must offer vaccination within 10 days from the start of employment O Post-exposure evaluations to any worker who experiences an incident O Follow-up at no cost to the employee O Labels and signs to warn about hazards O Warning labels must be attached to bio- hazard container/equipment/supplies
CONT. O Training and information to all employees O Employees must be provided information about blood borne pathogens, exposure, disease processes, process of evaluation, etc. . O Maintain employee training records and medical incident records O Occupational injuries and illnesses must be logged and tracked
Question #2 O Employer responsibility includes: O A. Written exposure plans O B. The written exposure plans to be updated every 2 years O C. Training and information to all employees O Both A and C
Exposure Control Plan O Full detail plan consists of “Engineering controls” O Primary way to minimize or eliminate exposure O Universal precautions O Bio-boxes O Safe equipment (shielded needles)
If Exposed- What Do You Do? O If you are stuck by a needle or a sharp object or exposed to bodily fluids and/or other potentially infectious materials: O Rinse area with soap and water O Skin disinfectant O Report to supervisor O Follow-up care
Remember O There is no law stating patients must tell medical providers they may have a potential infectious disease! O HIV O AIDS O HBV
Important Date in History O December 6 th, 1991 Bloodborne Pathogens Standards developed. O Only applies to areas of work where there is a high risk of exposure to infectious diseases. O Went into effect March 1992 O Students are not covered so you MUST protect yourself!
Chemical Hazard O Requires that employers inform employees of all chemicals and hazards in the workplace O Must provide Material Safety Data Sheets (MSDS’s) O Includes the hazardous product and ingredients O Instructions for use O Special precautions/protection O Spill/waste procedures O Health Hazard Data (first-aid)
Cont.
Occupational Exposure to Hazardous Chemicals Standard O Includes: O Identifying the types and locations of all O O O chemicals or hazards Locating and using the MSDS manual Reading and interpreting chemical labels and hazard signs Using personal protective equipment (PPE) Locating cleaning equipment and following correct methods of managing spills and/or disposal of chemicals Reporting accidents or exposures and documenting any incidents that occur
Question #3 O Material Safety Data Sheets (MSDS) include O A. Ingredients to all hazardous products and instructions for use O Special precautions, protections, and health hazard data O Spill, waste, or clean up directions O All of the above
Who Needs To Be Careful O Everyone in health care! O Dentists O Doctors O Aides O Nurses O Dental professionals O Respiratory O OT/PT/ST O Everyone in between (housekeeping, laundry, dietary, etc. )
Blood borne Pathogen Standard O Mandates to protect health care providers from diseases caused by exposure to body fluids O Example: O Blood, blood components O Urine/stool O Semen/vaginal secretions O Cerebrospinal fluids O Saliva/mucus
Trivia O According to the CDC, what leads to most visits to the ER? O Back injuries O Head injuries O Open wounds
For Your Information O One of the top 3 concerns of healthcare providers is: O Contracting a potentially infectious disease (45%)
It was just a few drops of blood…. but it happened! O http: //youtu. be/B 4 TG 1 Pg. XPhc
Question #4 O Healthcare workers most often become exposed to hepatitis B, hepatitis C, and HIV through accidental needle sticks? O True O False
Accidental Exposure O While accidental exposure occurs as evidenced by the video on the previous slide approximately 800, 000 needle sticks occur each year. O Prevention is the key O Equipment training O Proper equipment disposal
Re-capping a Needle is a NO! O Never recap a used needle no matter what! O Never stick your hands into a container containing sharps
Question #5 O Most needle stick injuries occur when disposing of needles, giving medication, drawing blood or handling trash? O True (most sticks are unexpected accidents) O False
Other things to remember! O Employer must provide PPE and PPE must be removed before leaving work area. O Do not eat or drink in a high risk area. O Label specimens and double bag if specimen will be leaving the facility
If an Exposure Occurs O Wash area immediately! O Report the incident O Fill out incident report O Possible testing O Possible treatment O If protocol is followed- employer is responsible for the employee’s care O Some facilities have spill stations
Written policies O Exposure control plan O Provide Hepatitis B Vaccination O PPE (Personal Protective Equipment) O Gowns, gloves, masks, eye protection, etc… O Clean and sanitary work environment O Proper containers for Bio-hazard disposal O Provide training
Blood borne Diseases O Hepatitis B (Can survive outside the body for a week. Vaccination to Prevent) O Hepatitis C (Can survive outside the body for almost 4 days and is the most common chronic blood borne infection in the US- NO CURE) O HIV/AIDS (cannot live outside the body and is the disease with the most misconceptions related to transmission- NO Cure) O Four modes of transmission specific for these three diseases: O O Sex Body Secretions Sharing Needles Blood Transfusions
HBV O 100 Xs more infectious than HIV O Can take 2 -6 months to show symptoms O Hep. C is most prevalent O Signs and Symptoms: O ABD pain (liver) O Joint pain O Fatigue O Yellowing of the eyes
Other Locations of Pathogens O O O O O Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental procedures Unfixed tissues or organs (living or dead)
More Trivia O The human body: Every square inch has about how many bacteria? O 2 million O 12 million O 22 million O 32 million
More Trivia O The human mouth contains more bacteria than there is people in the world! O When a person sneezes 100, 000 virus cells spread up to 30 ft. (remember a sneeze is over 100 miles per hour). O Human bowel contains over 100 billion disease causing organisms
Question #6 O Fortunately, there are vaccines available to prevent hepatitis B and hepatitis C, and HIV? O True O False (Vaccination to prevent B)
Understanding the Principles of Infection Control O Microorganisms are small living organisms that are not visible by the naked eye O Classified as either: O Pathogens O Nonpathogens O Bacteria O Viruses O Aerobic O Anaerobic O Everywhere!
Pathogens Related to Infection O Normal flora (colonization)- example: E. Coli in the bowel O Transient flora- example: staph on the skin O Pathogens are everywhere! O Relationship to infection: O Over growth of these pathogens can cause infection, especially in an immunocompromised person
Examples of Pathogens O Bacteria (one bacteria can multiply into 8 million cells in a 24 hour period). TB (Tuberculosis) Staph (Staphylococcus) Strep (Streptococcus) MRSA (Methicillin-resistant staphylococcus aurous) O VRE (Vancomycin-resistant enterococcus) O O O Viruses (infect cells, parasitic like nature, feeds off of uninfected cells to thrive) O Hepatitis O HIV O Common Cold/Flu
Nature of Micro-organisms O Disease producing micro-organisms are called pathogens (viruses and bacteria) O Ways to spread O Direct contact- actually touching the organism O Indirect contact- droplets/airborne O Flies, mosquitos, ticks, food (vectors) O Vehicle- inanimate objects
What is an Infection? O Infection is disease resulting from over growth of microbes O An infection can become life-threatening before an older person or someone who is immunocompromised realizes it O Local is one area of the body O Skin tear, pressure ulcer O Systemic is the whole body O Fever, increased pulse, and respiratory rate, pain/tenderness, fatigue, loss of appetite, N&V, redness/swelling, discharge or drainage, etc…
Types of Infection O Endogenous O Disease inside the body related to abnormalities O Exogenous O Disease outside of the body O Nosocomial O Disease contracted through health care O Opportunistic O disease contracted because of impaired immune systems
Signs and Symptoms of Infection O Fever O Confusion O Increased Pulse O Increased Respirations O Drainage and swelling
Internal Body Defense Mechanisms Against Pathogens O Mucous membranes O Cilia O Coughing/sneezing O Hydrochloric acid O Tears O Fever O Inflammation O Immune response- antibodies
Facts About Pathogens O Grow best at body temperature O Destroy human tissue by using it as food O Give off waste products that are called toxins O Toxins poison the body O Can rapidly spread and be deadly in someone who is immunocompromised
Environment for Pathogens O Moisture O Temperature O Oxygen O Lack of sunlight (dark) O Dead and living matter (nourishment)
Question #7 O A person has to be sick and showing signs and symptoms of sickness before he/she is able to pass bacteria or viruses to others? O True O False (pathogens are everywhere)
Medical Asepsis O Definition: the practice which helps reduce the number and transfer of pathogens from one place and/or person to another O Reason for practicing medical asepsis: O Micro-organisms are always present in the environment (although some normal). Some micro-organisms can cause illness in certain people (especially those who are immunocompromised)
Aseptic Techniques O Antisepsis- betadine/alcohol O Clean/prepare body with chemicals that eliminate/kill bacteria O Disinfection- (chemical) bleach/Lysol O Process of destroying harmful organisms O Can kill up to 99. 9% of bacteria O Sterilization- (heat) autoclaves O Destruction of ALL microorganisms O Important for surgical procedures, wound care, catheterization, etc…
Break the Chain of Infection
Center for Disease Control O A federal organization that developed standard precautions to minimize or prevent epidemics from spreading O Monitor risk factors, health practices, and rates of disease progression O Purpose is to protect and prevent the spread of illnesses O Hand washing, gloves, use of proper personal protective equipment
Hand Washing O Hand washing- single most important way to minimize pathogens! O O O When you arrive/leave the facility Before and after every patient contact After contact with non-intact skin Before moving from a contaminated body site Anytime hands become contaminated Before and after applying/removing gloves Before and after specimen handling After picking item up off the floor After you cough, sneeze, or use a tissue Before and after eating Before and after using the bathroom Before and after contact with your face/hair
Why Wash Your Hands? O Everything you touch has germs on it O You use your hands constantly O You can carry germs to others Your constant adherence to good hand washing prevents transfer of germs!
Hand washing
Types of Hand Washing O Normal hand washing- what you do before and after providing care O Surgical scrub- 2 minute or more scrub performed before surgical procedure O Antiseptic wash- scrubbing the skin with antiseptic (betadine or alcohol) before surgical procedure
Hand Washing Technique O Use lots of soap to produce lather O Vigorous scrubbing for 15 seconds or more to remove organisms O Clean all surfaces including nails and wrists O Point fingertips downward toward sink O Never touch the sink O Dry hands thoroughly and discard paper towel O Use dry paper towel to turn of faucet
Hand Sanitizer O Is appropriate when: O A sink is not available O And in between non-invasive care O Should NOT be used when caring for C-diff patients because alcohol does not effectively kill the spores associated with the pathogen Use according to manufacturer’s direction Apply to palm of one hand, rub hands together completely covering all surfaces of the hands with the sanitizer until hands and fingers are dry.
Gloving O The CDC and OSHA standards both state O Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin. O Must wash hands before and after gloving
Masks, Eye Protection, and Face Shields O Masks in combination with eye protection devises shall be worn whenever splashes, sprays, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated
Gowns, Aprons, and Other Protective Body Clothing O Appropriate protective clothing such as gowns, aprons, lab coats, or similar outer garments shall be worn in occupational exposure situations O Surgeries O Dental cares O ICU’s O Labor and Delivery O Respiratory cares O Emergency situations
Also includes O Isolation/Reverse Isolation O Purpose is to protect patient/s and self from contracting or spreading disease O Airborne precautions O Droplet precautions O Contact precautions Must wear proper PPE (gowns, gloves, masks, goggles, etc…) Must wash hands- no hand sanitizer!
Question #8 O The number one way to reduce the transmission of pathogens is to? O A. Wash your hands frequently O B. Wear gloves for all patient contact O C. Use hand sanitizer at all times O D. All of the above
Disease Examples O Tuberculosis (TB) is caused by a bacteria that attacks the lungs and is spread through the air O Flu- viral O Common Cold (virus) O Hepatitis A, B, C (virus) O MRSA (bacteria)
Reinfection & Cross Infection O Practicing medical asepsis can prevent O Reinfection- becoming infected a second time with the same disease O Cross infection- infected by microorganisms from another patient or member of staff Always wash hands between patients and procedures Always disinfect equipment after each use Always wear proper PPE
Other Ways to Prevent the Spread of Pathogens O Clean and disinfect equipment and patient rooms O Dispose of contaminated articles correctly O Be aware of surroundings and work to prevent environmental contaminations
Using Body Mechanics O Refers to the way in which the body moves and maintains balance while making the most efficient use of all its parts. O Helps prevent undue strain and helps with muscle strength O The number one musculoskeletal injury health care professionals experience is back injuries
Trivia O One of the top 3 concerns of healthcare providers are concerned about potential back injuries (59%)
Ergonomics O Is an applied science used to promote the safety and well-being of a person by adapting the environment and using techniques to prevent injuries. O Contouring the job to fit the person and keep them safe
Four Reasons for Using Good Body Mechanics O Muscles work best when used correctly O Correct use of muscles makes lifting, pulling, and pushing easier O Correct application of body mechanics prevents unnecessary fatigue and strain, and saves energy O Correct application of body mechanics prevents injury to self and others
Eight Basic Rules O Maintain a broad base of support O Bend from the hips and knees and get close to O O O the object while keeping your back straight Use the strongest muscles to do the job Use the weight of your body to help Carry heavy objects close to the body Avoid twisting Avoid bending for long periods If patient or object too heavy- GET HELP!
Equipment Safety O Do not operate or use any equipment until you O O O have been instructed on how to use it Read and follow the operating instructions for all major pieces of equipment Do not operate any equipment if your instructor of immediate supervisor is not in the room Report any damaged or malfunctioning equipment immediately! Do not use frayed or damaged electrical cords Store equipment properly Read MSDS before using hazardous chemicals
Patient/Resident Safety O Do not perform procedures on patients unless you have been instructed to do so O Provide privacy for patients O Always identify yourself O Always explain the procedure to the patient O Observe the patient closely O Check all safety points
Personal Safety O Remember it is your responsibility to protect O O O O yourself and others from injury Use correct body mechanics while performing any procedure Wear proper uniform Walk-Do not run Promptly report accidents/injuries If you see any unsafe situation or violation of safety practices, report it Keep all areas clean and neat Wash hands and keep hands away from face Work with your partner
Health Care Worker Safety O http: //youtu. be/0 CVk. Ep. Xp 7 ho
Question #9 O The number one musculoskeletal injury health care professionals experience? O A. shoulder injuries O B. Knee injuries O C. Back injuries O D. Ankle injuries
Fire Safety O Three things to start a fire O Oxygen O Fuel O Heat
Fire Extinguishers O Class A O Class B O Class C O Class D O ABC extinguishers O Most facilities use the combo type O Must receive training to operate
Safety Plan O Must be educated about fire safety plan (every facility is different) O Must have fire drills practicing fire emergency plan O RACE O Rescue O Alarm O Contain O Extinguish/evacuate
UMC Safety Dance Music Video O http: //youtu. be/kg-2 k. Ez. WIOI
Question #10 O The acronym RACE stands for what? O A. Run, alarm, contain, evaluate O B. React, Alarm, Constraint, Evaluation O C. Report, alarm, contain, emergency O D. Rescue, Alert, Contain, Extinguish/Evacuate
HIPAA
Privileged communications O HIPAA (Health Insurance Portability and Accountability Act 1996) O Security Rule- protect electronic records/faxes O Privacy Rule-protect identifiable health information O Protected Health Information (PHI) is privileged information O Must be kept confidential O Health care records O Protects patient, patient information, health care providers, prevents fraudulent use of sensitive information O Hospitals, all health care personnel, health insurance companies, financial providers, etc. .
Privacy Rule Transactions & Code Sets Rule Unique Identifiers Rule HIPAA Security Rule Enforcement Rule
PHI O Name O Address O Birth date O Social security number O Medical record number O Account number O Other identifying information
Examples of HIPAA Violations O Absence of a “Right to Revoke” Clause O Release of the wrong patient information O Release of unauthorized health information O Release of information to an undesignated party O Failure to adhere to the authorization expiration date
Cont. O Lack of patient signature on HIPAA form O Improper disposal of patient records O Unprotected storage of private health information O Failure to promptly release information to patients O Small-scale snooping
Rights of the Patient O You have the right to keep your health O O O information private You must sign an authorization to have your information shared with others You can ask to know who your information has been shared with In some cases your information must be shared with the police, CDC, etc. . You have a right to look at your chart and ask for copies Right to file a complaint if violation occurs
Question #11 O Patients have the right to have all personal health information kept private except when mandated by law? O True O False
Does NOT Protect or Prevent O Protect employee records O Prevent employers from asking for a doctor’s note O O if you are sick Protect when a state or federal law mandates that certain health information must be reported Protect when public health situations arise (CDC & FDA) Protect when government officials request for information Prevent incidental disclosures that are an unavoidable by-product of permitted uses or disclosures
Cont. O Prevent the use or disclosure of information O O for licensing, audits or investigation Prevent the disclosure of information for judicial and administrative proceedings Prevent the disclosure of information for law enforcement purposes Prevent the disclosure to a medical examiner to identify a deceased person or to determine the cause of death Prevent the uses or disclosures for health related research
Cont. O Prevent uses and disclosure to prevent a serious O O threat to health or safety Prevent the uses or disclosure of information related to specialized government function (military purposes, foreign services, etc. . ) Prevent disclosure of information related to worker’s compensation programs Prevent disclosure of information of a limited data set for research, public health, or health care operations Prevent disclosure of information to business associates who perform health care operations within the working facility a patient seeks services from
True Stories of HIPAA Violations O Arkansas: A physician and two co-workers plead guilty to HIPAA violations because they accessed a slain victim’s medical records to see if rumors related to cause of death were true O Iowa: some medical staff plead guilty for looking up medical records of some of the University of Iowa Football team players
Cont. O A doctor out to lunch with a client- texting another doctor medical information about a patient, setting his phone on the table, and no shutting off the lit screen. O Nurse accesses a patient’s medical records, shares the information with her husband, her husband calls and threatens the patient (patient and nurse’s husband collided in cars and there was a lawsuit).
Cont. O Husband wife both seeing individual counselors in the same practice. The two counselors discussed the couple. The wife’s counselor shared the information about her husband’s conversations with his counselor then she filed for divorce and used the information against him.
Cont. O Nurse works in ICU and accesses her mother and sister’s medical records, which has nothing to do with her job. O Bored at work and looking at patient medical information that does not pertain to the care of YOUR patients
Remember! O Minimum information rule O Only look up what you need to treat your patient. Anything above that is a violation of HIPAA!
Just Like Medical Treatment! O Just like giving medications, performing surgery, providing therapy, etc…. O Establish who the patient is!
Legal Obligations of Facilities O Legally obligated to keep health information that identifies the patient private. O Provide a copy of law to give you notice of the privacy policy O Obtain consent if information must be shared outside of the facility
How to protect patient information O Don’t gossip O Don’t repeat O Learn codes of ethics O Be aware of scope of practice O Keep charts in a safe place O Keep computers locked because health care records are privileged information O Inform patients about confidentiality rights O Initial and date all information and sign name
The HIPAA Song O http: //youtu. be/6 w. RDor. Q 73 Ng
Question # 12 O It is ok to share information with co- workers or family members of yours or the patient’s because it is important to share your day or let co-workers and patient family members know what is going on with the patient? O True O False
Legal Representative O Sometimes you have family members who request information related to the health status of a loved one. Encourage families to legally appoint a personal representative that will have the right to access health records on behalf of that patient. This would be referred to as Advanced Directives for Power of Attorney. O Additional information can be found: “A Patient’s Guide: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved In Your Care”
HITECH Act of 2009 O Health Information Technology Act of 2009 O Require additional safeguards to be in place because of the increased use of electronic medical records O Amendments to the privacy and security aspects of HIPAA to tighten the safety and security of electronic medical records O Facilities must always monitor, review, and modify security measures to prevent a possible breach of security O Must take steps to correct if breach occurs.
Civil Penalties 2014 Conduct of covered entity or business associate Penalty Did not know and, by exercising reasonable diligence, would not have known of the violation !100 to $50, 000 per violation; Up to $1, 500, 000 per identical violation per year Violation due to reasonable cause and not willful neglect $1, 000 to $50, 000 per violation; Up to $1, 500, 000 per identical violation per year Violation due to willful neglect and the violation is corrected within 30 days after the covered entity knew or should have known of the violation Mandatory fine of $10, 000 to $50, 000 per violation; Up to $1, 500, 000 per identical violation per year Violation due to willful neglect and the violation was not corrected within 30 days after the covered entity knew or should have known of the violation Mandatory fine of not less than $50, 000 per violation; Up to $1, 500, 000 per identical violation per year
Cont. O One single incident can result in multiple violations and lots of lost money! O Loss of a laptop (1 lap top, 500 patients = 500 violations). O Not too mention lawyer fees!
HIPAA Violations May Be A Crime Prohibited Conduct Penalty Knowingly obtaining or disclosing PHA without authorization Up to $50, 000 fine and one year in prison If done under false pretenses Up to $100, 000 fine and five years in prison If done with intent to sell, transfer, or use the PHI for commercial advantage, personal gain or malicious harm Up to $250, 000 and ten years in prison
Safeguards O O Assign HIPAA responsibility Know the use and disclosure rules Know individuals’ rights Implement and maintain written policies O O O O O Deceased persons Individual access to e-PHI Time for responding to request to access Limits on disclosures to insurers School immunizations Sale of PHI Marketing Fundraising Research Breach notification
Cont. O Develop complaint forms O Authorizations O Notice of privacy practices O Other forms O Execute appropriate business associate O O O agreements Perform and document a risk analysis Implement required safeguards Train workforce Respond immediately to any violation or breach Timely report breaches Document actions
What Business Associates Should Do to Comply O Determine whether business associate rules apply O Execute and comply with valid business associate O O O O O agreements Execute valid subcontractor agreement Comply with privacy rule Perform a security rule risk analysis Implement security rule safeguards Adopt written security rule policies Train personnel Respond immediately to any violation or breach Timely report security incidents and breaches Maintain required documentation
Question #13 O You can share your computer login with others as long as they work at the facility you work at? O True O False
Physical Safeguards O Facilities must limit access to health care records and sensitive information O Proper sign-in codes O Restricted access passes
Question 14 O What is the minimum information rule? O A. learning everything about your patient O B. learning the minimum information about all the patients who seek treatment at the facility where you work. O C. learning the minimum information necessary to adequately take care of your patient.
HIPAA Violations Video O http: //youtu. be/4 N 5 dv. Gp. VUGE
References O Youtube. com O http: //www. osha. gov/SLTC/healthcarefacili ties/index. html O http: //www. osha. gov/SLTC/healthcarefacili ties/standards. html O http: //www. cdc. gov/niosh/topics/bbp/genre s. html O http: //www. cdc. gov/oralhealth/infectioncon trol/faq/
O http: //www. osha. gov/Publications/osha 318 6. html O http: //www. osha. gov/Publications/OSHAfactsheet-HIPPA-whistle. pdf O http: //www. onesourcedoc. com/glog/bid/95 168/10 -Examples-of-HIPAA-Violations
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