Procedural
Requirements
Effective Date: March 16, 2023
Expiration Date: March 16, 2028
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NASA Procedural Requirements |
NPR 1800.1E Effective Date: March 16, 2023 Expiration Date: March 16, 2028 |
| | TOC | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | ALL | |
2.1.1 General
Clinics shall meet all applicable requirements of Federal and, where applicable, state regulations, professional standards, and other NASA program requirements.
2.1.2 Responsibilities
2.1.2.1 The CHMO shall establish policy requirements for the OM programs.
2.1.2.2 The OCHMO shall:
a. Ensure the oversight and advocacy of Center OM programs through periodic reviews.
b. Review any significant request for a change or relief of OH policy.
2.1.2.3 Centers shall:
b. Notify the CHMO when a Medical Director change occurs at their Center.
c. Train OM staff for the tasks they are required to perform and ensure OM staff meets all regulatory and NASA training requirements.
2.1.2.5 Medical Directors shall:
a. Ensure the program meets all Federal, state, and NASA requirements for that jurisdiction.
b. Ensure physicians and other healthcare providers (e.g., nurse practitioners and physician assistants) are appropriately credentialed in compliance with the requirements of NPR 1850.1.
c. Ensure physicians and other healthcare providers (e.g., nurse practitioners and physician assistants) are privileged in compliance with the requirements in NPR 1850.1.
d. Ensure employees who administer spirometry testing maintain certification from a National Institute for Occupational Safety & Health (NIOSH) approved course, as required by OSHA.
2.2.1 General
Clinics shall establish a medical quality assurance (QA) program that meets these requirements and those found in NPD 1850.1, NASA Medical System Quality Assurance and NPR 1850.1.
2.2.2 Responsibilities
2.2.2.1 The CHMO shall establish medical QA program policy.
2.2.2.2 The OCHMO shall ensure compliance with medical QA policy through regular periodic reviews.
2.2.2.3 Centers shall develop a comprehensive set of policies and procedures to meet the quality-of-care standards. See NASA Occupational Health Employee-Directed Principles and Management-Directed Principles located on the Agency OH website.
2.2.2.4 OM staff shall implement a medical QA program including establishing and monitoring medical QA program metrics to evaluate the program effectiveness based on the Center’s policies and procedures.
2.3.1 General
NASA OHPs will encompass primary prevention, health promotion, and a comprehensive safety program that impacts both individual health and Agency wellness.
2.3.2 Responsibilities
2.3.2.1 The OCHMO and Centers shall implement Health Promotion Programs through both Agency-directed and Center-planned activities and document appropriately selected metrics for benchmarking, continuous improvement of programs, and resource allocation, as a means of demonstrating the efficacy of primary prevention activities.
2.3.2.2 OH professionals shall provide prevention services such as medical examinations, health and wellness promotions, immunizations, food safety and sanitization services, assorted health screenings, and control of chemical and physical hazards.
2.4 Diagnosis and Treatment of Occupational Illness or Injury
Centers shall ensure timely diagnosis and treatment of occupational injuries and illnesses and act to minimize the recurrence of a similar problem in other coworkers and those in similar jobs.
2.4.2 Responsibilities
2.4.2.1 The CHMO shall set policy and provide oversight of clinical activities.
2.4.2.2 The OCHMO shall conduct regular periodic reviews to ensure the appropriate delivery of diagnostic and treatment services.
2.4.2.3 Centers shall:
a. Ensure when diagnosing and treating occupational illnesses and injuries they:
(1) Conduct an OH history for the assessment of work-related health problems and include total employment and general health histories, with a review of systems and determination of any pre-existing conditions to achieve an accurate medical diagnosis.
(2) After a health history is taken, perform an appropriate physical examination with a detailed specific organ or system examination as related to the chief complaint. Laboratory and radiological testing may be used to complement the history and physical examination and to aid in the diagnosis and treatment of the condition.
Note: Pre-approval may be required for procedures not routinely performed in the OH Clinic.
(3) Via the Medical Director, or qualified designee, when the Medical Director is unavailable, review the care of employees for appropriateness with current standards of care, utilizing published clinical practice guidelines.
(4) Via the Medical Director, or qualified designee, document any inconsistencies with a work-related injury or illness and report these to a safety and health representative for further evaluation of the injury mechanism and circumstances.
(5) Via OM staff or a safety and health representative, perform an assessment of the workplace to reinforce the importance of injury prevention and implementation of approved reasonable accommodations.
(6) Coordinate with OSMA regarding any occupational illness or injury as required by NPR 8621.1.
b. Report any developing trends in occupational injury and illness to the CHMO.
2.4.2.4 Medical Directors shall:
a. Ensure accurate diagnosis, timely treatment, and appropriate follow-up of all occupational injuries and illnesses in employees seen in Clinics and report all work-related injuries and illnesses to Center employees responsible for OSHA recordkeeping.
b. Monitor occupational injuries and illnesses for trends, analysis, and Corrective Actions (CA).
2.4.2.5 Practitioners shall become familiar with employees' work and the environment in which they work. To better understand specific medical issues and cases, it may be necessary for the medical staff to visit the workplace to better understand the mechanism of injury and evaluate health, safety, and ergonomic concerns.
2.4.2.6 OM staff shall coordinate and communicate with NASA FWC Injury Compensation Specialists (ICS) to provide claim-related documents generated at the OH Clinic, assist with an explanation of occupational-related illnesses and injuries for which a claim is being made, and make recommendations about employee return-to-work options.
2.5.1 General
Maintaining immunity will be an integral part of NASA's disease prevention and infection control programs to reduce potential health effects related to exposure to vaccine-preventable infectious agents.
Note: The number and types of immunizations required per employee will vary based upon exposure risk.
2.5.2 Responsibilities
2.5.2.1 The CHMO shall establish an Agency immunization policy.
2.5.2.2 The OCHMO shall ensure Center immunization policies are in place and the medication management process is sound, properly documented, and meets NASA QA Program elements through regular periodic reviews.
2.5.2.3 Medical Directors shall:
a. Establish immunization policies and procedures and ensure immunization services are available in such areas as international travel, medical surveillance/job certification, occupational injuries/illnesses, and preventive medicine.
b. Ensure the medication management process is sound, properly documented, meets NASA QA Program elements, and follows the most current Centers for Disease Control and Prevention (CDC) recommendations.
2.5.3 Process
2.5.3.1 Employees with a reasonable risk of occupational exposure to vaccine-preventable diseases such as tetanus or hepatitis A or B, will be offered appropriate vaccinations if they lack documented immunity in accordance with Bloodborne Pathogens, 29 CFR § 1910.1030.
2.5.3.2 Employees who decline the hepatitis B vaccination are required to sign a declaration form acknowledging the vaccination is a vital element of prevention against exposure to bloodborne pathogens.
2.5.3.3 Tetanus and diphtheria status will be reviewed during each employee evaluation and immunization made available for all employees with tetanus prone injuries at work and those requiring routine boosters if the time since the last immunization exceeds the current guidelines.
2.5.3.4 The employee will be provided an opportunity to discuss any questions about the immunization procedure prior to vaccine administration.
2.5.3.5 An immunization record will be maintained for each employee, reviewed as part of each employee encounter, reflect documented disease and immunization histories, as well as immunizations administered during employment, and updated at each immunization encounter.
2.6.1 General
Centers shall determine the roles and responsibilities of OH disciplines based on specific needs at each of the Centers.
2.6.2 Responsibilities
2.6.2.1 The CHMO shall:
a. Provide technical support and policy guidance to the Centers to effectively negotiate and delineate the roles and responsibilities of OH in relation to the Center-specific emergency management plan.
b. Provide guidance documents and contribute suggestions to improve medical response.
2.6.2.2 The OCHMO shall ensure Clinics have addressed emergency management specific to their structure and operations through regular periodic reviews.
2.6.2.3 Centers shall:
a. Keep the OCHMO current on any Center specific emergency events or any significant modifications to the Emergency Management Plan as they relate to OH roles and responsibilities.
b. Serve as an advocate for OH disciplines to ensure assigned roles and responsibilities are sound, obtain management support as needed, and keep the lines of communication viable between the stakeholders.
c. Ensure the OH roles and responsibilities in the Center emergency management plan are reasonable and clearly stated.
d. Ensure OH disciplines are fairly and consistently represented in the planning process and in drills and simulations with their comments and concerns considered for incorporation into the plan.
e. Ensure management support is solicited for appropriate funding for supplies, staff training, and skill mix and number.
2.6.2.4 Medical Directors shall:
a. Establish procedures to meet the medical expectations of the emergency management plan including, but not limited to, skill mix and number, employee training and drills, equipment, and supplies.
b. Establish measures to safeguard and retrieve medical records in paper or electronic format per 5 U.S.C. § 552a, Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, (1996), (HIPAA), where applicable, and NPR 1441.1.
c. Ensure OM staff are appropriately trained, and adequate supplies are readily available.
d. Support other OH disciplines in meeting their respective requirements in disaster management such as supporting the EAP in Critical Incident Stress Management (CISM) training and debriefing.
2.6.2.5 Clinics shall:
a. In addition to the Center-wide plan, address emergency management specific to their structure and operations.
b. Have emergency management policies and procedures in place for emergency operation of the Clinic and support of the Center emergency management plan.
c. Integrate their roles and responsibilities into the Center emergency management plan.
2.7.1 General
Clinics shall support the Center in formulating their Continuity of Operations Plan (COOP).
2.7.2 Responsibilities
2.7.2.1 The CHMO shall provide technical support and written policy direction to OM staff in support of the Center COOP.
2.7.2.2 The OCHMO shall ensure support is provided to Centers in formulating their COOP and Clinics have programs in place to direct OM staff in support of Center emergency management plans through regular periodic reviews.
2.7.2.3 Medical Directors shall provide expert consultation to the COOP manager and Center management on related public health and medical issues.
2.7.2.4 Clinics shall:
a. Support formulation of a Center COOP which should be designed as a supplement to the Center's emergency management plan and address the hazards appropriate to the Center, such as pandemics, hurricanes, earthquakes, or other major disasters. The COOP can be an annex to the Center emergency management plan or a stand-alone plan.
b. Ensure communication with HQ emergency management throughout all phases of emergency response.
2.8.1 General
Medical surveillance protocols will be used at all Centers. The Physical Examination Requirements (Appendix C) provides examination procedure requirements for most routine and specialty examinations performed at Centers.
Note: The categories of physical examinations provided at Clinics are listed in Appendix C, Physical Examination Requirements. Appendix C will be updated via the NODIS administrative change process, as necessary.
2.8.2 Responsibilities
2.8.2.1 The CHMO shall establish policy, provide requirements and oversight, and review Center physical examination programs.
2.8.2.2 The OCHMO shall ensure oversight of Center physical examinations through regular periodic reviews.
2.8.2.3 Centers shall utilize medical surveillance protocols as detailed in the Physical Examination Requirements (Appendix C).
2.8.2.4 Medical Directors shall ensure the overall quality of care provided by all healthcare providers. In all situations where the decision regarding medical qualification or certification is unclear, the Medical Director, or qualified designee when the Medical Director is unavailable, is responsible for reviewing the clinical information and making the final decision.
2.8.2.5 Evaluating physicians shall:
a. Interpret all physical examination test results and determine their significance. Findings will be reviewed, and employees will be informed and advised if additional follow-up is recommended. Clinically significant or critical test results will be conveyed to the employee and documented as per local critical values policy. If the examinations are not performed onsite, the Medical Director, or qualified designee, when the Medical Director is unavailable, will review the results before final clearance is issued to perform the required task.
b. Prepare any required healthcare professional's written opinion for the pertinent standard, within the specified timeframe.
2.8.2.6 Clinics shall:
a. Develop and maintain effective systems for managing abnormal employee results including prompt review by the evaluating provider and notification to the employee consistent with the significance of the finding.
b. Ensure the protocol requirements for the following job categories:
(1) Specific potentially hazardous exposures.
(2) Hazardous environments/workplace examinations.
(3) Certification examinations.
(4) Flight activities.
(5) Special administrative examinations.
(6) Voluntary health maintenance examinations.
2.8.3 Process
2.8.3.1 Placement of employees in the various physical examination programs is determined by job category, workplace surveys, and specific exposure events.
2.8.3.2 Special administrative examinations and health maintenance examinations are offered according to Agency and Center policies.
2.8.3.3 Typically, employees whose jobs are associated with exposures to hazards with regulatory requirements established by OSHA or NASA are placed in medical surveillance.
2.8.3.4 Some programs have specific guidance for placement (e.g., asbestos, organophosphates pesticide workers, hearing conservation, and radiation workers).
2.8.3.5 If insufficient monitoring data or no data is available, individuals will be placed in medical surveillance based on potential exposures and job title. When this occurs, individuals are to be reassessed as work-site monitoring data becomes available.
2.8.3.6 When an employee is no longer actively exposed to a hazard, as confirmed by the supervisor, the employee will be removed from that medical surveillance group unless the physician determines the employee should remain in a monitoring status.
2.8.3.7 Physical examinations will conform to the requirements delineated in the Appendix C, Physical Examination Requirements, OCHMO-STD-1880.1, NASA Aviation Medical Certification Standards, and the pertinent Federal regulations.
2.8.3.8 Physical examination frequency varies and includes:
a. Baseline evaluation.
(1) This evaluation should ideally be performed before the employee starts work in a position with a potential for hazardous exposure.
(2) This evaluation provides information necessary to determine if the employee is qualified to perform the job. It also provides a baseline against which changes can be compared.
(3) Baseline evaluations and certifications will be performed prior to engaging in any activity that could be hazardous to the employee or other employees working near or adjacent to them or in contact with them.
b. Periodic evaluation.
(1) This evaluation will be performed periodically during the time an employee is employed in a job requiring an examination.
(2) The frequency and extent of periodic evaluations may vary depending on the work being performed, pertinent regulations, findings from previous examinations, the history of exposure, and/or the age and gender of the employee.
c. Variable or exposure-determined evaluation.
(1) These evaluations will be conducted in response to a specific hazardous exposure incident and prompt the examination of all individuals with the suspected exposure, not just those already in the surveillance program.
(2) These evaluations may vary significantly from routine medical surveillance protocols, are usually exposure specific, and include biological monitoring tests.
d. Exit/reassignment evaluation.
(1) This evaluation will be performed when the employee terminates employment or the job position or is permanently removed from a position which has a potential for hazardous exposure.
(2) Documentation of the employee’s state of health at the termination of employment or exposure is essential for comparison purposes if the employee later develops medical problems that could be attributed to past occupational exposures.
(3) This evaluation is not required if a periodic evaluation has occurred within the prior six months.
2.8.3.9 If a physical examination has been conducted within the previous six months and has been duly recorded in the employee's health record, it may, at the discretion of the examining physician, be accepted in whole or in part as the requested medical examination so long as the workplace hazards have not changed.
2.8.3.10 A physical examination conducted for one purpose will be valid for any other purpose within the prescribed validity period if that physical contains the proper data, in accordance with the following:
a. If the examination is deficient in scope, only those tests and procedures necessary to meet the additional requirements will be performed.
b. The results will be recorded, and appropriate approval provided by the examining physician.
2.8.3.11 A clear determination of medically qualified vs. medically certified or medically disqualified vs. not medically certified will be made.
2.8.3.12 As appropriate for the type of examination, any limiting factors or restrictions will be noted so reasonable accommodations for employees may be considered by the Agency. For additional information, see NPR 3713.1, NASA Policy on Reasonable Accommodation, Americans with Disabilities Act of 1990, 42 U.S.C. § 12101, and Rehabilitation Act of 1973, 29 U.S.C. § 701 et seq.
2.8.3.13 If additional tests or other actions are needed for qualification or certification (e.g., failed vision because corrective lenses are not available, additional tests are needed, or a temporary condition exists like a cold or the flu) and the condition represents a potentially immediate hazard to the employee, fellow employees, or the success of the project/mission, the employee will be placed on a modified duty status and a follow-up appointment made to either qualify or disqualify the employee.
2.8.3.14 Where no written standard has been established for a function, providers shall use best medical judgment to determine whether a disqualifying impairment exists. The Medical Director is responsible for review and final recommended work status in these cases.
2.8.3.15 Appeal or second opinions will be handled at the lowest level of authority at the Center.
2.8.3.16 When a standard written medical opinion is required by regulation, but no standard format is established by Occupational Safety and Health Standards, 29 CFR 1910 as in the case for lead, bloodborne pathogens, respiratory protection, silica, beryllium and asbestos, the format in Figure 2-1, Standard Written Medical Opinion, will be used.
| Standard Written Medical Opinion | |
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| Healthcare Provider Name: | |
| Signature: | Date: |
Figure 2-1 Standard Written Medical Opinion
2.8.3.17 The employer, NASA or contractor, per the contract, shall provide a copy of the written opinion to the affected employee.
2.8.3.18 Unless otherwise noted, the standard written medical opinion will be sent within 14 days of completion of the physical examination and receipt of laboratory studies.
2.9.1 General
Initial Clinic response in an emergency to stabilize the patient until the emergency transport to appropriate medical facilities arrives. Clinics are not designated emergency facilities and do not provide emergency medical care as part of their regular scope of services. After stabilization, Emergency Medical Services (EMS), per their contract, if necessary, shall transport emergent and urgent patients to the nearest appropriate emergency facility, and not to an OH Clinic.
2.9.2 Responsibilities
2.9.2.1 The CHMO shall provide policy guidance and technical support to ensure all Centers have emergency medical response capability that is consistent with published guidelines.
2.9.2.2 The OCHMO shall ensure appropriate OH response in an emergency medical situation through regular periodic reviews.
2.9.2.3 Center Directors shall provide oversight of all NASA and NASA-contracted EMS providers. This oversight involves administrative and medical review of all runs, provision of standing orders, and ensuring the EMS are adequately staffed and equipped and comply with all NASA, state, and local EMS requirements as practical given contract and locality-specific requirements.
2.9.2.4 Medical Directors shall ensure a first responder program that includes AED capability according to the Center-wide AED policy, collaborating with other Center stakeholders as appropriate.
2.9.2.5 EMS, per their contract, as necessary, shall ensure the following minimal requirements:
a. Ambulance and EMS requirements adhere to all state and local regulations, where applicable.
b. Advanced life support capability with a response time within eight minutes, at least 90 percent of the time.
c. First responders with AED capability response time of four minutes or less for most Center employees.
d. EMS providers participate in the Center-wide emergency response plan, under the direction of the on-scene incident commander.
e. EMS providers participate in emergency drills and exercises to enable full understanding of their responsibilities within the emergency management plan.
2.10.1 General
Centers shall have an AED program which implements the requirements contained in this section.
2.10.2 Responsibilities
2.10.2.1 The CHMO shall establish the NASA AED policy and program requirements.
2.10.2.2 The OCHMO shall ensure compliance with AED policy through regular periodic reviews.
2.10.2.3 Centers shall:
a. Perform an annual assessment of the site to determine the appropriate number of AEDs needed, where they should be located, based on population and demographics, layout of facilities, and level of risk in the facility environment, allowing for an optimal response time.
b. Have a written Center-wide AED program that includes roles and responsibilities, medical equipment and supplies, operational protocols, equipment maintenance, responder training and drill requirements, and a QA plan.
c. Integrate the AED program with the Center emergency management plan or as a reference or an appendix to that plan.
d. Perform an annual review of the AED program incorporating the annual assessment, findings, and CAs from drills or actual uses, equipment maintenance trends, and the Center AED plan.
2.10.2.4 Medical Directors shall provide oversight and medical direction for the Center AED program.
2.11.1 General
Bloodborne Pathogens (BBP) plans will address the requirements of the 29 CFR § 1910.1030. BBP plans will differ based on additional state and local requirements, where applicable.
2.11.2 Responsibilities
2.11.2.1 The CHMO shall:
a. Provide guidance and technical support for the development and implementation of BBP plans.
b. Communicate guidance documents via the Agency OH website and provide oversight and evaluation of the BBP plan during the review process.
2.11.2.2 The OCHMO shall ensure OHPs have current BBP plans through regular periodic reviews.
2.11.2.3 Centers shall:
a. Establish a written BBP plan that:
(1) Identifies at-risk employees (those with reasonable risk of exposure).
(2) Specifies medical surveillance and evaluation will include the offer of hepatitis B immunization, declination of offer to vaccinate (if applicable), post exposure evaluation and treatment, necessary follow-up, and issuance of the written medical opinion letter.
(3) Addresses methods of compliance with universal precautions, engineering and work practice controls, PPE, housekeeping, and biohazardous waste processing.
b. Ensure collaboration between the disciplines, especially when more than one contractor or tenant organization is involved.
c. Ensure operations are in compliance with the plan's requirements and the plan addresses the following issues:
(1) A culture of open communication among directorates and disciplines such as medical, IH, facilities operations, training coordinators, supervisors, and safety employees.
(2) Active participation in both the development and implementation phases.
(3) Consistent documentation and recordkeeping of all the requirements such as training, medical surveillance and immunization, biohazardous waste, and post-exposure prophylaxis.
(4) Enforcement of medical confidentiality and security of health information per 5 U.S.C. § 552a and, where applicable, Pub. L. 104-191.
d. Advocate for a work environment conducive to the success and consistent application of the BBP plan.
2.11.2.4 Medical Directors shall:
a. Review the BBP plan annually, or more frequently as needed, to ensure currency.
b. Establish policies and procedures to ensure compliance with the BBP plan and that treatment is available for all employees in the event of an actual exposure in compliance with 29 CFR § 1910.1030. This may include but is not limited to:
(1) Providing oversight for the content and/or delivery of related training classes.
(2) Provision and documentation of hepatitis B vaccine to at-risk employees free of charge.
(3) Documentation of declination of offer to vaccinate and the process by which the employee may obtain the vaccine later.
(4) Post-exposure prophylaxis plan.
(5) Medical confidentiality.
(6) Issuing the medical opinion letter in compliance with the BBP Standard.
c. Specify in the plan the means to protect and train the at-risk employees in accordance with 29 CFR § 1910.1030.
d. Ensure the BBP plan is accessible to employees and serves as the foundation of the respective employer's plan.
e. Establish a process by which they can address any deviations from the BBP Plan and review the plan annually in collaboration with the affected directorates and disciplines.
2.11.2.5 OH employees shall be a resource and assist in writing the BBP plan.
2.12.1 General
Centers shall have an infection control program which implements the requirements contained in this section.
2.12.2 Responsibilities
2.12.2.1 The CHMO shall establish an infection control program policy which includes oversight and evaluation of OH infection control programs.
2.12.2.2 The OCHMO shall ensure Centers have current infection control plans through regular periodic reviews.
2.12.2.3 Centers shall:
a. Institute a systematic, coordinated, and continuous infection control program that focuses on surveillance, prevention, and control of infections. Center programs will encompass all patient care activities to reduce risks of nosocomial/clinic-acquired infections.
b. Ensure implementation of activities designed to reduce risk of transmission of infections among healthcare employees, students, and visitors.
2.12.2.4 Centers will provide particular focus for infection control on direct employee care practices, ancillary services (e.g., laboratory, radiology, and rehabilitation), support services (e.g., linen supply), and fitness centers.
2.12.2.5 Medical Directors shall:
a. Ensure an infection control program is established and maintained at their Centers and adequate resources, including time and training, are available to support the program.
b. Ensure the infection control plan guidelines and practices will:
(1) Address patient care issues such as hand-washing practices, approved antiseptics and disinfectants, sterilization of equipment and disinfecting the clinic, laundry, housekeeping, ventilation, and environmental sampling.
(2) Establish a medical surveillance program for healthcare employees, including immunizations, post-exposure protocols, and work restrictions/accommodations.
(3) Include the BBP Plan and a tuberculosis prevention and control plan.
c. Ensure appropriate and timely action is taken on all infection control issues or problems and a process for follow-up has been established to ensure effectiveness of the CA.
d. Ensure training of healthcare employees on infection control methods as required by Federal OSHA regulations is accomplished. For infection control, the training will include the following:
(1) Newly assigned healthcare employees receive infection control training within ten working days of placement in the clinical environment.
(2) Healthcare employees annually receive infection control training, including OSHA BBP, standard and transmission-based precautions, and PPE training.
(3) Healthcare employees receive training when significant regulatory changes occur.
(4) Healthcare employees providing direct care to employees receive continuing education on patient care practices to minimize the risk of nosocomial-acquired infections.
e. Ensure all training documentation and continuing education records are kept in the healthcare employees’ records in accordance with NASA records management guidelines.
f. Designate at least one person to the role of Infection Control Officer (ICO) for their Center.
2.12.2.6 ICOs shall:
a. Oversee the infection control program and have specific knowledge and training relevant to infection control to keep current on regulatory changes.
b. Establish, maintain, and oversee an infection control plan and an Infection Control Committee (ICC) consisting of a physician, a nurse, and any additional staff necessary to manage the program effectively. The ICC coordinates all activities related to the surveillance, prevention, and control of nosocomial infections.
2.12.2.7 ICOs and/or ICCs shall:
a. Develop, implement, and maintain an infection control plan that includes program goals, surveillance activities, infection control guidelines, infection control training, nosocomial/clinic-acquired infections reporting process, program assessment, performance improvement procedures, and program documentation.
b. Review the infection control plan based on the proceeding year's infection control data. The review should include infectious waste disposal, shelf life of all stored sterile items, reprocessing of non-disposable items, housekeeping contract, linen services, radiology, and laboratory services.
c. Review and update the infection control guidelines and practices every three years.
d. Regularly review and summarize infection control issues and data, including infections and communicable diseases, immunization status of healthcare employees, and tuberculosis skin testing conversion data to determine if trends are being formed.
e. Conduct facility inspections at any location where medical care is provided at least annually, to ensure compliance with infection control standards.
f. Ensure all healthcare employees and facilities comply with applicable Federal, state, and local regulations, including notification of the public health agency when employees or healthcare employees are treated for infectious or communicable disease.
2.12.2.8 OH employees shall:
a. Use the checklist from the Agency OH website to facilitate implementation and assessment of infection control.
b. Request training materials, general information, and infection control reference materials if not already provided by their supervisor.
2.13.1 General
Centers shall adhere to the requirements for medical record management established in this section, NPR 1850.1, and NASA-EHRS-RMP-000.
2.13.2 Responsibilities
2.13.2.1 The CHMO shall establish medical information management policy and evaluate the Centers' medical information management policy and procedures.
2.13.2.2 The OCHMO shall periodically conduct a review of Centers' medical records management policies and procedures through the regular review process to ensure the EHRS complies with 5 U.S.C. § 552a and NPR 1441.1.
2.13.2.3 Centers shall:
a. Use the designated Agency EHRS in accordance with NPR 1441.1 unless an OCHMO waiver is approved.
b. Maintain and safeguard medical records in accordance with Federal and, where applicable, state laws and regulations (e.g., OSHA), NPR 1441.1, NPR 1850.1, and this document.
c. Establish and maintain medical record policy and procedures addressing access to medical records, release of records and to whom, copying of records, and privacy and confidentiality in compliance with Privacy Act - NASA Regulations, 14 CFR pt. 1212 and other applicable Federal and, where applicable, state laws and regulations.
d. Establish and maintain a policy on managing sensitive health information per 5 U.S.C. § 552a and, where applicable, Pub. L. 104-191 requirements which addresses the separate storage of those records and/or coding to preclude direct identification of the employee. Sensitive health information includes all EAP records, mental health, chemical dependency, sexually transmitted diseases, and drug and alcohol test results.
2.13.2.4 Medical Directors shall:
a. Ensure the Clinic has a medical information management policy consistent with NASA-EHRS-RMP-000.
b. Ensure an individual medical record is established and maintained beginning with the first medical encounter.
c. Ensure medical record documentation includes adequate information to identify the employee, employee medical history, reason for visit, subjective and objective findings, assessment, and plan written in the subjective objective assessment plan format. In addition, the medical record may include the information in Table 2-1, Medical Record Information.
Table 2-1. Medical Record Information
| Medical Record Information |
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| Employee demographics. History and medical questionnaire Work-related injury and illness reports Environmental hazards or conditions Occupational exposures and incidents Summary sheet Consultation reports Signed informed consent Laboratory test and x-ray results Immunizations Medication(s) provided or prescribed Allergies Referrals to community healthcare providers |
2.13.2.5 OH employees shall maintain accurate and complete occupational medical records and ensure the security and confidentiality of those records.
2.14.1 General
2.14.1.1 The potentially detrimental impacts of unusual shifts and prolonged worktimes will be given a high priority by all Centers to prevent employee psychological and physiological stress and undesirable outcomes. Safe work practices that minimize human error factors, especially fatigue, require safe work-rest cycles and shift scheduling.
2.14.1.2 In situations where there is conflict between this document and NPR 7900.3, Aircraft Operations Management, the latter will supersede the requirements contained herein.
2.14.1.3 Work-rest cycles will take into consideration and make proper allowances for the work environment, including temperature extremes. The criteria presented in this section are provided to ensure safe work practices and mission success.
2.14.1.4 The criteria provided for critical and non-critical positions is as follows:
a. A critical position is one in which the employee’s job performance can directly impact ground safety, flight safety, or mission success. This may include, but is not limited to, employees who:
(1) Deal directly with flight hardware, software, or ground support equipment.
(2) Have authority to make decisions regarding flight hardware or software processing.
(3) Are involved in launch and landing activities.
(4) Work in ground systems with physical or functional interface with flight systems.
(5) Work with hazardous sequences or procedures.
(6) Work on systems with minimal or no checks and balances related to employee decisions or actions.
Note: Employees who are in critical roles on a part-time basis will be considered as in a critical position on a full-time basis for purposes of work-rest cycle limitations.
b. All other positions are non-critical.
2.14.2 Responsibilities
2.14.2.1 The CHMO shall issue relevant policy and directives and provide supporting advocacy and resources.
2.14.2.2 Center Directors shall:
a. Ensure policies regarding work-rest cycles, implementation of work-rest cycles, maximum work limits, and shift schedules, as required for routine, extended, or emergency work scenarios, are adhered to and establish those positions designated as critical for each Center or facility.
b. Ensure appropriate resources to cover nominal operational requirements without deviations to the stated maximum work hours or work-rest cycle guidelines.
c. Ensure appropriate resources to satisfactorily cover unexpected absences without having individuals work more than 12 hours per day or negatively impacting the work-rest cycles.
d. Ensure maintenance of accurate records of work schedules and hours worked.
e. Review all schedules and deviations, at least annually, to determine if revisions are warranted to avoid future deviations.
2.14.2.3 Deputy Center Directors or equivalent designee shall:
a. Consult with the OCHMO prior to approving any deviations to established policy.
b. Consult with safety and complete a risk assessment for any potential deviations from established policy.
c. Be responsible for approving Center deviations, including during Center or program declared emergencies, after careful consideration of mission requirements, local conditions, and risk assessment, and report all deviations executed to the OCHMO.
2.14.2.4 Managers and supervisors shall:
a. Establish schedules that comply with all required work hour limitations.
b. Ensure all duty hours are recorded and counted toward the maximum work periods identified below and report any work-rest cycles that are not within the established policies to the designated management level for risk assessment and approval of deviations, given the current work requirements. Work time data will be available for review.
c. Consult with a safety, medical, or fatigue specialists prior to any missions that have the potential for work-rest cycles to exceed the maximum work periods established policy.
d. Complete training related to importance of sleep, sleep hygiene, symptoms of fatigue, and fatigue avoidance measures.
e. Ensure employees performing prolonged routine shifts receive training related to importance of sleep, sleep hygiene, the adequate sleep times required between shifts, symptoms of fatigue, and fatigue avoidance measures.
2.14.2.5 OH staff shall assist in policy development and provide professional consultation to managers and supervisors regarding requirements for standard and prolonged work schedules and work excesses. Supervisors should seek out fatigue risk management expertise, as necessary.
2.14.2.6 EH managers shall assure potential exposures are appropriately evaluated, and Occupational Exposure Limits (OEL) are adjusted, as necessary, from the eight-hour time-weighted average to reflect actual conditions and work shifts.
2.14.3 Process
2.14.3.1 For non-critical positions, employees shall not work more than the following Maximum Work Times (MWT):
a. 12 consecutive hours (16 consecutive hours in emergency situations with approval).
Note: If traveling for work results in cumulative travel time greater than 16 hours, a Center or program declared emergency is not required. However, employees will complete no additional tasks or work requirements at the completion of the final leg of their travel.
b. 60 hours during a seven-day work week.
c. Seven consecutive days without at least one full day off.
d. 240 hours during a four-week period.
e. 2,500 hours during a rolling 12-month period.
2.14.3.2 Deviations for non-critical positions from these MWT times require approval by a designated supervisor. Prior to approval, the designated supervisor shall perform a risk assessment and consideration of human factors safety issues, with the assistance of a human factors consultant, safety professional, or medical professional, to ensure excess hours do not result in negative outcomes for the employee or mission.
2.14.3.3 For critical positions, employees shall not work more than the following MWTs:
Note: Pre-approval by Deputy Center Director or equivalent, in consultation with the OCHMO, is required for deviations after completion of risk assessment and consideration of human factors safety issues, for critical positions.
a. 12 consecutive hours (16 consecutive hours may be exceeded with a high level of designated approval only during a Center or program declared emergency).
Note: If traveling for work results in cumulative travel time greater than 16 hours, a Center or program declared emergency is not required. However, employees will complete no additional tasks or work requirements at the completion of the final leg of their travel.
b. 60 hours during a seven-day work week.
c. Seven consecutive days without at least one full day off (deviations may be pre-approved or up to 18 consecutive days with two full days off required after the extension period).
d. 240 hours during a four-week period.
e. 2,500 hours during a rolling 12-month period.
2.14.3.4 Under no circumstances will an employee be required to work such that there is not at least eight hours off duty between shifts. A minimum of ten hours off duty is preferred and 12 hours or more is optimal to accommodate employee commute time and domestic and sleep needs.
2.14.3.5 When the eight-hour period is shifted within the 24-hour day-night cycle (shift work), compensatory time will be allowed for circadian rhythms to adapt. Forward rotating shifts, from day to evening to night, rather than counter to it are easier for human adaption.
2.14.3.6 The traditional standard five-day, eight-hour shift is becoming frequently replaced with consecutive ten or 12-hour shifts, compensated to the employee by more time/days off. The basic 12 hour/day schedule will be two-on, two-off, three-on, three-off, or four-on, four-off. Three consecutive 12-hour shifts are optimal. Working more than four consecutive 12-hour shifts is associated with excessive fatigue and strongly discouraged since it may result in significant impact on performance of duties, mission, and safety.
2.14.3.7 Time zone changes alter or shift natural bodily rhythms and require considerable time to reach new equilibriums as evidenced in the well-known jet lag syndrome. Consideration should be given to allowing for adaptation times to avoid critical decisions in a chronobiologically impaired state. Circadian rhythms affect physical ability, mental alertness, decision making, and overall well-being that can predispose to injury and adversely impact work capacity, quality, and safety.
2.14.3.8 To minimize employee stress and fatigue related to time factors, the following procedures will be followed:
a. Define the standard work period for all operations and tasks, including method of shift rotation if required, as well as breaks and required rest cycles.
b. Clarify responsibilities, work expectations, and desired outcomes for any process or decision.
c. Ensure appropriate resources to meet all maximum work time and work-rest cycle requirements, without deviations, including addressing contingency situations.
d. Minimize negative consequences of shifting work times by:
(1) Having employees select preferred shifts consistent with mission needs.
(2) Considering individual circadian rhythms to insure adequate work and sleep-rest cycles.
(3) Allowing adequate time for adaptation and recovery from old to new shift or time zone.
(4) Understanding the criticality of the work to evaluate risk of physiological and psychological consequences of chronobiological stress.
e. Define critical job categories and ensure employees assigned to these categories understand the full implications of the work schedule and rest cycles. Educate employees about the importance of adequate rest for safe job performance.
f. Define extended work periods for job categories.
g. Allow deviations from standard maximum work requirements by the following criteria:
(1) Need, urgency, and benefit.
(2) Risk assessment.
(3) Prior anticipation of extended work schedules or deviations from guidelines as noted in position descriptions.
h. Provide an impartial council (e.g., HMTA or the Agency DASHO) to hear and resolve disagreements related to work schedules, shift work, and rest cycles.
2.14.3.9 Overtime may be required because of a problem during operation or because of an extended work process. In either case, supervisors shall not approve overtime to exceed the stated requirements.
2.14.3.10 Emergency or extremely unusual circumstances can require work performance essentially at endurance capacity. This will be invoked only for life-threatening emergencies, natural disasters, mass casualty accidents, or war.
2.14.3.11 The calendar year, the week, and the calendar day (which changes at midnight) will be used for work time evaluation and maintenance of accurate time records.
2.14.3.12 A qualified industrial hygienist shall determine adjustment and application of OEL's to unusual shifts using the Brief and Scala model or other acceptable models as described in Harris, R., Patty’s Industrial Hygiene.
2.15.1 General
2.15.1.1 NASA provides civil service employees, before and during official OCONUS travel or assignment, support to reduce the risk of illness or injury, prevent loss of productivity, and safeguard health. Support is provided through NASA Clinics and an Agency medical services contract managed by the OCHMO. Support for civil service employees before and during OCONUS travel includes medical emergencies and non-emergencies, referrals, medical evacuation, and repatriation of mortal remains. Support from the Agency medical services contract provider for travel issues/incidents unrelated to official government business and/or on personal time are the responsibility of the employee.
2.15.1.2 Contractor OCONUS emergencies and provision of non-emergency services are the responsibility of the contractor company, in accordance with NASA FAR Supplement, 48 CFR §1852.242-78. Contractor companies are responsible for establishing health and medical clearance policies and facilitating arrangements with external medical service providers for their employees. Centers may provide pre-travel medical support for contractors in some circumstances.
2.15.1.3 Intergovernmental Personnel Act detailees, students, and interns shall adhere to OCONUS travel assistance policies, arrangements, and requirements specified in their organizations’ agreements with NASA.
2.15.2 Responsibilities
2.15.2.1 The CHMO shall establish health policy for civil service employee official OCONUS travel.
2.15.2.2 The OCHMO shall ensure proper implementation of Center OCONUS travel policy through regular, periodic reviews of NASA Clinics.
2.15.2.3 Clinics shall:
a. Establish procedures for providing pre-travel support and medical services (e.g., exams and vaccine information) for civil service employees scheduled for official OCONUS travel or assignment. For more information see CDC Yellow Book 2020: Health Information for International Travel.
b. Inform OCONUS travelers about vaccines, foreign country medical alerts, and other travel-related information utilizing resources such as the CDC, World Health Organization (WHO) health information for international travel, and the U.S. Department of State.
c. Offer pre- and post-travel support. Examples of support are provided in Appendix C.
d. Be aware of, and communicate to travelers, other sources of health-related information, such as:
(1) Name and number of the Agency medical services contract provider, Contracting Officer Representative, and NASA websites available for additional guidance.
(2) Post-travel exam scheduling and advice, as required.
2.15.2.4 Clinics may conduct pre-travel confirmation of the Tuberculosis (TB) intra-dermal skin test status with purified protein derivative, if applicable. Clinics shall follow the CDC guidance on follow-up for positive results and post-travel evaluation of skin test status for those who traveled to areas where there are high incidences of TB.
2.15.2.5 Clinics may assemble and issue medical kits for NASA civil service employees preparing for official travel. Medical Directors shall develop the instructions for and contents of the medical kits.
2.15.2.6 Clinics may provide civil service employees who plan to go on official travel with a summary of their previous and current medical history, including allergies, medications, and special diet, in accordance with privacy and confidentiality requirements.
2.15.3 NASA contract for emergency and non-emergency support services to civil service employees on official OCONUS travel. Benefits under the Agency medical services support contract for medical services, medical evacuation, repatriation of mortal remains, and other assistance are available to civil service employees traveling OCONUS on official travel and in activities sanctioned by NASA. Contract support to civil service employees on OCONUS travel may also apply to civil service employees who are transitioning, or have completed, international permanent change of station activities. Centers that award separate medical service contracts to assist specific NASA civil service and/or NASA contractor employees on official OCONUS travel are not associated with the OCHMO contract that provides support NASA-wide.
2.15.4 Funding for medical support services to civil service employees on official OCONUS travel
Centers are financially responsible for medical support services related to emergency medical services (e.g., hospitalization and ground/air transport) for their civil service employees on official OCONUS travel. OCHMO will coordinate with the lead(s) of the affected civil service employee’s program, mission directorate, and/or Center to arrange for timely funding of the support services and transferring monies to the OCHMO to ensure payment to the Agency medical services support contract provider.
2.15.5 Repatriation of mortal remains of civil service employees who died while on official OCONUS travel
2.15.5.1 The CHMO shall serve as the primary Agency Point of Contact (POC) in coordination with representatives from the Agency medical services support contract provider in communications with foreign country authorities (e.g., medical examiner, city officials, authorities who participate in investigations, and unofficial foreign representatives inquiring about an incident).
2.15.5.2 The OCHMO shall coordinate the repatriation of civil service employee mortal remains with the Office of the Chief Financial Officer (OCFO) to ensure payment of expenses incurred in accordance with NPR 9780.1, Payment of Expenses Connected with the Death of Certain Employees.
2.15.5.3 The Agency medical services support contract provider shall coordinate with the OCHMO to arrange for repatriation civil service employee mortal remains.
2.15.6 To gather required information in the most efficient manner with the least impact on the family and colleagues of the deceased civil service employee, the OCHMO, OCFO, NASA Shared Services Center (NSSC), and other NASA program points of contact with pertinent information will coordinate closely.
2.15.7 Accidents, injuries, and deaths reporting
2.15.7.1 Civil service employees who become injured or ill during official travel may be eligible for coverage by the Federal Employees’ Compensation Act (FECA) and should consult with the NSSC injury compensation specialists for assistance as soon as possible. Survivors (e.g., spouses, dependents) of civil service employees who die during official travel are eligible to apply for FECA benefits.
2.15.7.2 Civil service employees who have been involved in a close call or accident or who sustain occupational injuries or illnesses, even while on official business travel, are required to notify their supervisors as soon as possible. NPR 8621.1 provides detailed information on mishap reporting.
| TOC | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | ALL | |
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