Attachment 9 AFRC Policy Documents 2020.pdf

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Armstrong Flight Research Center AFEI-260-001, Baseline-2 Edwards, California 93523 Expires June 1, 2021

Compliance is mandatory.

SUBJECT:

Niton XLp-300A X-Ray Fluorescence Analyzer Usage

RESPONSIBLE OFFICE:

Medical and Health Branch

Niton XLp-300A X-Ray Fluorescence AFEI-260-001, Baseline-2 Analyzer Usage Expires June 1, 2021

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CONTENTS

1.0 SCOPE, APPLICABILITY, & WAIVER

1.1 Scope

1.2 Applicability

1.3 Waiver

2.0 REQUIRED EQUIPMENT

3.0 ROLES & RESPONSIBILITIES

3.1 Radiation Safety Officer

3.2 Industrial Hygienist

4.0 TRAINING

5.0 ANALYZER OPERATION

5.1 Radiation Emission

5.2 Radiation Personal Monitoring

5.3 Radioactive Materials Log Book

5.4 Radiation Leak Testing

5.5 Battery Charging

5.6 Maintenance, Cleaning, & Repairs

5.7 Storage, Transport, & Shipping

5.8 Modes of Operation

6.0 LEAD PAINT ANALYSIS

6.1 Instrument Start-Up & Shut-Off

6.2 Calibration

6.3 Measurement

6.3.1 Lead (Pb) Paint Mode Menu

6.3.2 Standard Mode Sampling

6.3.3 K & L Mode

6.3.4 Trigger-And-Proximity Sensor Method: Field Sampling

7.0 DOWNLOADING DATA

8.0 MANAGEMENT RECORDS & RECORDS RETENTION

9.0 RELEVANT DOCUMENTS

9.1 Authority Documents

9.2 Forms

APPENDIX A, Definitions

APPENDIX B, Acronyms

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1.0 SCOPE, APPLICABILITY, & WAIVER

1.1 Scope

This procedure applies to the use of the Niton analyzer for lead (metal) measurements in materials.

1.2 Applicability

This procedure applies to all personnel in the Armstrong Flight Research Center (AFRC) who are authorized and trained to use the Niton analyzer.

1.3 Waiver

No part of this document may be waived.

2.0 REQUIRED EQUIPMENT

Niton XLp-300A X-Ray Fluorescence Analyzer (XRF).

3.0 ROLES & RESPONSIBILITIES

3.1 Radiation Safety Officer

The Center Radiation Safety Officer is responsible for oversight of personnel using this operating procedure and ensuring personnel receive training on the proper use of this equipment.

3.2 Industrial Hygienist

The industrial hygienist is responsible for ensuring this equipment is properly charged and in good working order at all times. As written in this procedure, the industrial hygienist will ensure that the equipment is properly identified and calibrated. As necessary, the industrial hygienist will ensure proper shipping of the Niton analyzer for any necessary manufacturer calibration or equipment service.

The industrial hygienist will ensure that any Niton users are required to wear a dosimeter, which will be sent to a radiation detection group for analysis on a quarterly basis. Results are reviewed, and, in the case of a positive result, discussed with the employee. Copies of all reports are given to the employee, the employee’s supervisor, and placed in the employee’s medical personal file.

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The industrial hygienist will ensure the calibration results are recorded on AFRC 80258, Niton XLp-300A Field Data Form.

4.0 TRAINING

Personnel who use the Niton analyzer will receive initial and annual training regarding the proper and safe use of the Niton analyzer. Initial and annual training will be presented by the Niton Corporation via an online training module covering radiation safety, monitoring, and measurement technology. The Center Radiation Safety Officer will ensure such training is obtained.

5.0 ANALYZER OPERATION

5.1 Radiation Emission

The Niton analyzer contains a sealed 40-millicurie cadmium-109 source.

It is designed so that there is virtually no measurable radiation external to any part of the instrument when the shutter is closed. When the instrument is used according to instructions, there is minimal radiation exposure even with the shutter open.

A. The user will not hold the analyzer near the kapton measurement window during testing. The user will NEVER point the analyzer at one’s self, or anyone else, when the shutter is open.

B. The user will always remain aware of the location of the analyzer’s radioactive source and the direction of its beam of x-rays (the location of the source of radiation is at the front end of the analyzer, with a 20° upward angle).

C. During testing, the user will remain aware that a strong beam of radiation is continuously emitted through the kapton window at the front of the analyzer. There will be some radiation at the front and top-front of the analyzer. There is negligible radiation at the handle of the analyzer.

D. When testing the exterior of a window sash from the inside of a room, the user will avoid standing in the path of the Niton’s radiation beam.

E. When taking a measurement, the user will always ensure no one is present on the other side of walls and windows. (Radiation during testing can pass through walls and possibly affect unknowing individuals on the other side).

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F. To open the shutter and to keep it open, the user will hold instrument against a surface. (The Niton analyzer is designed so that one cannot accidentally open the shutter or leave it open when lifting the analyzer from a surface).

G. The user will open the shutter ONLY during a test. (The three light-emitting diode (LED) lights will blink whenever the shutter is open).

H. In the unlikely event that the shutter becomes stuck in the open position, or the liquid crystal display (LCD) touch screen displays the message “SHUTTER DOES NOT OPERATE”, the user will:

1. Remove the battery;

2. Place the instrument in its shielded holster;

3. Place holster in the shielded carrying case; and

4. Call Thermo Scientific’s Service Department at: (800) 875-1578, or 1-918-670-7460.

I. The user will ensure that all shutters close immediately and remain locked in the closed position when the battery pack is detached from the instrument.

J. If the Niton analyzer is lost, stolen, or damaged, the user will notify the

AFRC Radiation Safety Officer immediately (following the Niton User’s Guide, page 11).

5.2 Radiation Personal Monitoring

The user will wear a radiation dosimeter badge anytime the analyzer is handled.

5.3 Radioactive Materials Log Book

The user will fill out form AFRC 80257, Radioactive Materials Log Book, before each day’s use. (Of note, 10 CFR, Sub-part L, requires that this logbook be kept as long as the Center has the Nuclear Regulatory Commission license).

5.4 Radiation Leak Testing

The industrial hygienist will ensure the Niton analyzer is wipe-tested every six months, pursuant to manufacturer protocol. In addition, properly trained personnel will wipe test the Niton analyzer prior to shipment, and after receipt of the returned unit. The industrial hygienist will place a copy

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of the most current leak testing results in the Niton storage case, along with the completed AFRC Form 80257.

5.5 Battery Charging

The Niton analyzer is powered by a lithium ion battery pack, which provides six to eight hours of continued use. When not in use, the Niton analyzer battery pack will discharge at a rate of about 8% per day, and 70% per month. The industrial hygienist will take the following steps to ensure proper charging of the Niton analyzer battery packs:

A. Remove the battery packs from the charger after charging is complete.

(Overnight charging is recommended).

B. Use the battery packs until they are approximately 80% discharged before recharging them. (A partially charged battery may be recharged).

C. Change battery packs in a clean, indoor environment, because moisture and dirt can cause damage to the battery. (See Niton user’s guide, Chapter 9, pages 1-3, or detailed instruction on removing and replacing battery packs).

5.6 Maintenance, Cleaning, & Repairs

ALL service except exterior cleaning will be performed by Niton Corporation.

5.7 Storage, Transport, & Shipping

A. The industrial hygiene technician will:

1. Call the Niton Corporation for a return authorization (RA) number before shipping the Niton analyzer back to the factory for any reason.

2. Ship the Niton analyzer in its original padded carrying case with a shipping combination padlock.

3. Ensure shipment is performed pursuant to federal and state regulations.

B. Perform leak testing within 6 months of shipment. The leak test certificate will be included with the Niton analyzer whenever it is shipped.

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5.8 Modes of Operation

There are four modes of operation for the Niton analyzer:

1. Alloy testing

2. Pb (lead) paint mode

3. Thin samples test modes (i.e., wipes)

4. Bulk sample test modes (i.e., soil, paint chips)

The Niton analyzer at the Center will only be used in the Pb (lead) paint mode. (If a decision is made to use the Niton analyzer for thin and bulk sample analysis and the necessary additional software and equipment is purchased, this DEI will be modified with those specific user’s instructions).

6.0 LEAD PAINT ANALYSIS

6.1 Instrument Start-Up & Shut-Off

A. Push and hold the On/Off/Escape button for at least 3 seconds (until the analyzer beeps) to turn the analyzer on.

B. Push and hold the On/Off/Escape button for at least 10 seconds to turn off the analyzer. The analyzer will beep as the unit counts down to turn off.

C. On start-up, the screen will be replaced by a restart screen that will automatically count down from 9 to 0 in increments of one second.

D. When restart is complete, the restart screen will be replaced by the logon screen. Tap anywhere on this screen to continue.

E. The logon screen will be replaced by a warning screen, advising that the analyzer produces radiation when the lights are flashing. You will acknowledge this warning by selecting the ‘yes’ button before logging on.

F. A password is required to log on. After selecting the ‘yes’ button, the virtual numeric keypad becomes available to log on to the analyzer.

G. After being powered on, the Niton 300 series analyzer will perform an internal recalibration before an analysis is initiated. The user will

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therefore allow the instrument warm up for at least ten minutes after start up, before beginning any testing.

6.2 Calibration

A. Factory Calibration: Factory calibration is required whenever self-calibration or field calibration fails to bring the instrument into acceptable tolerance.

B. Self-Calibration: The user will perform pre- and post- calibrations every time the analyzer is used for sampling. To access the calibration menu, select the calibrate icon from the utilities menu. (The calibration menu enables calibration of the analyzer’s electronics).

1. Select the calibration detector icon to begin a standard calibration of the analyzer’s detector.

2. Once the calibrate detector icon has been selected, calibration will begin immediately. The analyzer is programmed to calibrate for a specific, predetermined period in order to ensure proper operation of the Niton analyzer in the field. The user will avoid any vibration, loud noise, strong electronic interference when the analyzer is calibrating its detector.

3. The analyzer calibration screen will be displayed until calibration is finished. The calibration results will be displayed. The user will press the On/Off/Escape button or the Return icon to return to the main menu.

4. The user will record all calibration status on form AFRC Form 80258, indicating a pass or fail.

6.3 Measurement

There are five different methods of operation for taking a lead sample measurement. The preferred analyzer configuration is the “trigger-and-proximity” sensor method.

6.3.1 Lead (Pb) Paint Mode Menu

All Niton XLp 300 series lead-in-paint analyzer mode functions are accessible from the Pb paint mode menu and subsidiary menus.

Each of the instrument functions represented by an icon on the Pb paint mode menu screen may be selected by choosing the appropriate icon. When one of these Pb paint mode menu icons is selected, the function-specific submenu appropriate to that icon will be displayed. All lead-in-paint modes use both L and K shell analysis simultaneously.

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6.3.2 Standard Mode Sampling

The standard mode icon allows selection of the lead-in-paint standard mode. Standard mode is a qualitative analysis designed for 95% confidence level as to whether the sample is above or below the action level. The standard mode tends to give very fast readings as it terminates the test as soon as 95% confidence has been achieved. Standard mode is used in field sampling.

6.3.3 K & L Mode

The K & L mode icon allows the selection of the lead-in-paint K & L mode. K & L mode is a quantitative analysis, which allows determination of the statistical confidence of the reading to a 95% confidence level while allowing the flexibility of continuing the test for as long as is required, up to the maximum test time.

6.3.4 Trigger-And-Proximity Sensor Method: Field Sampling

With the trigger-and-proximity sensor method, the user will place the sample to be analyzed against the measurement window to engage the proximity sensor on the front of the instrument, then pull the trigger to initiate sample analysis.

7.0 DOWNLOADING DATA

The Niton analyzer can store up to 3,000 measurements in all paint modes. The data can be downloaded to a computer to print reports or to insert data into the database.

Details regarding downloading data can be found in the Niton user’s manual, Chapter 8.

8.0 MANAGEMENT RECORDS & RECORDS RETENTION

See the Medical and Health Branch record plan and inventory for storage location, retention requirements, and ultimate disposition for the following management records associated with this procedure. Records will be maintained in the in accordance with current NRC regulations, Title 10 CFR, Part 20, Sub-part L, Records.

The records:

1. AFRC 80257, Radioactive Materials Log Book

2. AFRC 80258, Niton XLp-300A Field Data Form

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9.0 RELEVANT DOCUMENTS

9.1 Authority Documents

Nuclear Regulatory Commission (NRC) Regulations

Title 10 CFR, Part 20, Sub-part L, Records

9.2 Forms

NASA forms may be found at https://nef.nasa.gov/nef/.

AFRC 80257 Radioactive Materials Log Book

AFRC 80258 Niton XL-309 Field Data Form https://nef.nasa.gov/nef/

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APPENDIX A, Definitions

Can or may Denotes discretionary privilege or permission.

Shall All mandatory actions (i.e., requirements) are denoted by

"shall."

Should Denotes a good practice and is recommended, but not required.

Will Denotes expected outcome or action. A “will” statement implements a requirement and is auditable.

APPENDIX B, Acronyms

AFRC Armstrong Flight Research Center

ALARA as low as reasonably achievable

DCP centerwide procedure

DFRC Dryden Flight Research Center (In hyperlinks, forms, document titles, etc. until updated.)

DOP organizational procedure

LCD liquid crystal display

LED light-emitting diode

NASA National Aeronautics and Space Administration

NPD NASA Policy Directive

NPR NASA Procedural Requirements

NRC Nuclear Regulatory Commission

RA return authorization

XRF x-ray fluorescence analyzer

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Document History Log Review Date: May 9, 2016

This page is for informational purposes and does not have to be retained with the document.

Baseline, 05/26/2016 Replaces DEI-S-007.

Admin Change, Baseline-1, 08-29-17 Updated document number from DEI-X-001 to AFEI-600.

Updated Code letter to Branch name.

Admin Change, Baseline-2, 01-25-18 Updated document number from AFEI-600 to AFEI-260-001 per Center instruction.

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This document has been reviewed by the Center Export Administrator and does not contain ITAR content. Armstrong distribution only. Contact the MSO regarding external distribution.

Armstrong Flight Research Center AFOP-1800.1-002, Revalidation A-4 Edwards, California 93523 Expires September 1, 2023

Health Unit Operating Procedures

Medical and Health Unit

Health Unit Operating Procedures AFOP-1800.1-002, Revalidation A-4 Expires August 1, 2023 content. Armstrong distribution only. Contact the MSO regarding external distribution.

AFOP-1800.1-002, HEALTH UNIT OPERATING PROCEDURES

Concurrence Signatures

By signing this concurrence, I accept the requirements that apply to my organization.

Dwight Peake, MD, MPH, Branch Chief Date

Expires September 1, 2023 content. Armstrong distribution only. Contact the MSO regarding external distribution.

Contents

1.0 SCOPE, APPLICABILITY, & WAIVER

1.1. Scope

1.2. Applicability

1.3. Waiver

2.0 OBJECTIVES & METRICS

3.0 ROLES & RESPONSIBILITIES

3.1. Center Chief Medical Officer (CMO)

3.2. Medical Director

3.3. Chief Nurse

3.4. Clinician Nurse Practitioner

3.5. Registered Nurse Staff Nurse

3.6. Technical Document Specialist

4.0 PROCEDURES

4.1. Physical Examination Procedures

4.2. Abnormal Vital Signs

4.3. Electrocardiograms (EKG)

4.4. Audiograms

4.5. Tuberculosis (TB) Skin Testing Procedures

4.6. General Laboratory Collection Procedures

4.7. Blood Specimen Collection (Venipuncture)

4.8. Urine Specimen Collection

4.9. Abnormal Laboratory Values

4.10. Fitness Center Operations

4.11. Medical Information Management

4.11.1. Table 1: Employee Health Record Chart Components before 4/2012

4.11.2. Table 2: Employee Health Record Chart Components after 4/2012

4.12. Confidentiality of Health and Medical Information

4.13. Copies of Medical Records

4.14. Disposition of Health and Medical Records

4.15. Medication Management

4.16. Health Unit Infection Control

4.17. Medical Waste

4.18. Bloodborne Pathogens

4.19. Respiratory Infection Control

4.20. Aerosol-Generating Procedures

4.21. Clinic Emergency Response Procedures

4.21.1. Assembly Points

4.21.2. Earthquake

4.21.3. Non-Earthquake (Fire, Chemical Spill, Smoke & Fumes, etc.)

4.21.4. Workplace Hazards

4.21.5. Medical Transportation

4.22. Quality Assurance and Performance Improvement

4.23. Performance Improvement

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4.24. Calibration of Medical Equipment

4.25. Daily Calibration

5.0 MANAGEMENT RECORDS & RECORDS RETENTION

6.0 RELEVANT DOCUMENTS

6.1. Authority Documents

6.2. Referenced Documents

NASA Occupational Health Program

6.3. Forms

1.1. Scope

This procedure applies to Health Unit general operations.

1.2. Applicability

This procedure applies to all staff members who work in the Health Unit, including clinician (physician and nurse practitioners), as well as registered nurses (RNs) and administrative staff.

1.3. Waiver

Specific requirements within this document may be considered for waiver only with proper, written justification, at the discretion of the Chief Medical Officer (CMO). If granted, waivers will be time-limited, and a written copy of the waiver will be kept on file in the office of the CMO until the expiration date of the waiver.

2.0 OBJECTIVES & METRICS

Objective: Ensure the safety and accountability of medications and supplies.

Target: Zero discrepancies on medications and supplies.

Metric: Number of discrepancies per month.

Metric data collection and formulation: Notification of the CMO by e-mail from the chief nurse.

Where reported: Occupational Health Monthly Management Meeting (OHM3) with the Health Unit staff.

How often reported: Monthly.

Objective: Prevent bloodborne pathogen exposure incidents.

Target: Zero incidents.

Metric: Number of incidents per month.

Metric data collection and formulation: NASA Mishap Information System (NMIS) entry.

Where reported: OHM3 with the Health Unit staff.

How often reported: Monthly.

3.1. Center Chief Medical Officer (CMO)

The CMO will advocate for funding to meet all programmatic requirements within the scope of service being provided and will be responsible for meeting all pertinent Federal, State, and National Aeronautics and Space Administration (NASA) requirements for Health Unit Operations.

3.2. Medical Director

The Medical Director, who will maintain a current Medical Board of California State of California license to practice medicine, will develop and maintain Standing Orders and Protocols for the Health Unit staff to include the Nurse Practitioner and Registered Nurses that specifically address chest pain and anaphylactic or anaphylactoid reactions, as well as physical examination requirements and standards that address those occupational jobs or exposures required by OSHA or by the NASA Office of the Chief Health and Medical Officer. The Medical Director will also perform Nurse Practitioner Oversight and ensure that at least one of either the Medical Director or the Nurse Practitioner maintain current status as Certified and Registered as a Federal Motor Carrier Safety Administration (FMSCA) Medical Examiner. In addition to performing medical flight clearances for Qualified Non-Crewmembers, the Medical Director is responsible for performing FAA and NASA First, Second, and Third Class aviation medical certifications, duties which require the Medical Director to maintain current Federal Aviation Administration (FAA) designation as a Senior Aviation Medical Examiner. When on duty onsite, the Medical Director is also responsible for responding to emergency calls for people at AFRC who have acute cardiovascular events, and, therefore, the Medical Director will keep a current American Heart Association certification as an Advanced Cardiac Life Support Provider.

3.3. Chief Nurse

The Chief Nurse, who will maintain a State of California professional Registered Nurse license, oversees the day-to-day operation of the Health Unit, and ensures that at least one Health Nurse is current in National Institute of Occupational Safety and Health (NIOSH) training for administering Pulmonary Function (Spirometry) training. The Chief Nurse is responsible for functioning as the Health Unit Inventory Control Officer and the Armstrong Flight Research Center (AFRC, hereinafter referred to as Center) Automated External Defibrillator (AED) Coordinator, and for ensuring appropriate Health Unit equipment is calibrated and undergoes content. Armstrong distribution only. Contact the MSO regarding external distribution.

routine preventive maintenance. In addition, the Chief Nurse is responsible for the Health Unit’s portion of the bi-annual NASA Occupational Health Program Audit, is responsible for maintaining certification by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and for ensuring that all Health Unit Registered Nurses maintain CAOHC certification, and is responsible for performing audiograms for OSHA Hearing Conservation Medical Monitoring Program participants. The Chief Nurse is also responsible for maintaining a current American Heart Association certification as an Advanced Cardiac Life Support Provider and as a Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator, and First Aid Instructor.

3.4. Clinician Nurse Practitioner

A Center Occupational Health Unit Nurse Practitioner, who is responsible for maintaining a State of California professional Registered Nurse license meeting the California Board of Registered Nursing Holding Out Regulations for Nurse Practitioners, maintaining certification by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and administering audiograms as needed, and maintaining current American Heart Association certification as an Advanced Cardiac Life Support Provider, is further responsible for making critical judgments in conducting health assessments, making differential diagnoses, and prescribing pharmacological and non-pharmacological treatments in the direct management of acute and chronic illnesses and injuries, within the scope of state regulations and Center Health Unit guidelines. This individual is responsible for implementing care through independent action, health counseling, and collaboration with other members of the Occupational Health team, including nurses, physicians, and the Center Medical Director.

The Center Nurse Practitioner is responsible for providing a range of services, from job-certification physical examinations to medical surveillance exams, to assessment and treatment of acute occupational illnesses and injuries, as well as some administrative duties with the primary focus being to promote optimum workplace safety and health, prevent illness and injury, as well as evaluate and treat occupational illnesses and injuries. The Center Nurse Practitioner is responsible for following the guidance of the directing Physician and for using specific Center Health Unit protocols for providing Occupational exams.

The Center Nurse Practitioner is also responsible for assessment and treatment of Center personnel who present to the Health Unit for urgent or emergent conditions, such as unstable angina, acute myocardial infarction, pulmonary embolus, or cerebrovascular accident (stroke) and for expeditiously responding in the Health Unit Medical Emergency content. Armstrong distribution only. Contact the MSO regarding external distribution.

Response Vehicle (MERV) with the supporting RN(s) to 911 Emergency Medical calls. If no physician is present, the Center Nurse Practitioner is then responsible for directing and assisting with medical response at the scene to stabilize treated individuals to the extent possible in accordance with standard BLS protocols, and when needed, start ACLS and Center written protocols and to determine if EMS Ambulance response is needed for transport to an off-site Emergency Department. The Center Nurse Practitioner is responsible for recognizing all instances where the clinical situation is beyond the scope of training and/or practice of the Center Nurse Practitioner, and, in these situations, the Center Nurse Practitioner is responsible for consulting the contracted physician for further assessment and disposition. In an emergency, and if the contracted physician is not available, the Clinician may contact the Center Chief Medical Officer for direction.

3.5. Registered Nurse Staff Nurse

A Center Health Unit Staff Nurse, who is accountable for maintaining a State of California professional Registered Nurse license, certification by the Council for Accreditation in Occupational Hearing Conservation (CAOHC), and current American Heart Association certification as a Basic and Advanced Cardiac Life Support Provider, is responsible for obtaining and recording employee medical information and health histories, performing physical exams and diagnostic tests, counseling employees regarding healthy lifestyles and other aspects of medical education, administering medications, performing wound care, interpreting medical information, determining necessary actions where appropriate, and consulting with nurse supervisors and physicians to determine medical plans.

3.6. Technical Document Specialist

The Center Health Unit Technical Document Specialist is responsible for using good interpersonal skills in person, by phone, and with email and for understanding how to follow written and oral instructions. The Technical Document Specialist is also responsible for exhibiting the ability to read, speak, and understand English fluently, for employing basic office skills, including typing at least 40 words per minute, filing, and phone management, and for appropriately using of job related computer skills.

4.0 PROCEDURES

4.1. Physical Examination Procedures

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Employees, whether civil servants or contractors, are often required to have a physical examination performed in order to perform their job function. In some cases, such as fitness center clearances or executive physicals, these examinations are optional. In any case, specific requirements for each type of examination are found in NPR 1800.1D, Occupational Health Program Procedures. Implementing these requirements through the Health Unit entails the following:

A. Examination is requested, usually by phone call, by either the employee, or a representative for the employee (e.g., supervisor, scheduler, etc.), to the Health Unit technical document specialist, who will schedule the examination(s) accordingly.

B. Some examinations are conducted in two visits (i.e., two different days) and some are conducted all in one visit. Two-visit examinations are required if blood work is drawn; in those cases the test results will come back in order for the clinician to accomplish the second part.

Information on which exams are one-part versus two-parts is found in

NPR 1800.1D.

C. After an employee has scheduled an appointment, the technical documents specialist will send the form AFRC 10858, Medical Clearance Request, to the individual electronically for the employee and their supervisor to complete, as well as any other forms that need to be completed, in accordance with examination requirements found in NPR 1800.1D. If the individual has not been seen in the Health Unit before, a new chart will be created (see Section 4.11).

D. Upon completion of the paperwork, the Health Unit RN will accomplish the required parts of the examination, depending on which examination is requested (and based on the requirements of NPR 1800.1D).

E. After the RN has completed requirements, the chart will be given to the clinician (e.g., either nurse practitioner or physician), who will review the paperwork and Cority® electronic health record (EHR) chart, then conduct a medical examination.

F. After examination, the clinician will complete the form AFRC 10858, Medical Clearance Request, indicating the clearances for which the individual meets standards, as well as the expiration date(s) of the clearance. Any restrictions, as appropriate, will also be noted. The clinician will then sign, date, and stamp the form with their name stamp.

G. The individual will be made aware of the clearances for which the individual meets standards, and with some clearances will be asked to acknowledge such by signing the medical clearance request form. The Health Unit staff will make a copy and give it to the individual.

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H. After the clinician has finished with the employee’s chart, the technical documents specialist will scan the paperwork into Cority® EHR and then re-file the chart in the filing cabinet.

4.2. Abnormal Vital Signs

A. The RN will provide immediate attention to all employees presenting with abnormal vital signs. Upon determination of significantly abnormal vital signs, the nurse will immediately contact the clinician. For the purposes of this document, abnormal vital signs are defined as the following, alone or in combination:

1) Pulse: Resting pulse less than 50/minute or more than 100/minute, or of an irregular rhythm.

2) Blood Pressure: Greater than 160 or less than 90 systolic; greater than 105 or less than 50 diastolic. Employees whose systolic BP is 210 mm Hg or greater or diastolic BP is 120 mm Hg or greater, and/or those with symptoms, will be referred immediately to the clinician. Symptoms include any of the following, alone or in combination: visual changes, numbness and/or tingling in the extremities, headache, diaphoresis, dizziness, or slurred speech.

3) Respiration: Respiratory rate greater than 20 breaths per minute;

as well as difficult breathing, noisy breathing, or breathing with retractions.

4) Temperature: Oral temperature greater than 103 degrees Fahrenheit.

4.3. Electrocardiograms (EKG)

A. Current EKG (also known as ECG) equipment will perform a standard 12-lead tracing and provide an automated interpretation. These automated interpretations may present both false negative and false positive readings. Therefore the EKG interpretation (e.g., “Normal”, “Otherwise Normal”, and “Borderline”) will be used as a guide, in conjunction with the employee’s history, signs, and symptoms, and other factors, in evaluating cardiac status. For EKGs where the lower limb lead is placed on the torso, “Limb lead on torso” will be written on the EKG printout.

B. The Health Unit clinician will be consulted regarding any EKG read as “Abnormal” on the automated interpretation, to determine if the abnormality requires immediate attention. The employee will be informed about the clinical significance of any abnormality. Counseling and referral recommendations will be clearly documented in the medical record.

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C. If the EKG indicates a life-threatening situation, the principles of Basic Life Support (BLS) and/or Advanced Cardiac Life Support (ACLS) will take precedence over the accomplishment of an EKG. These principles include the application of a defibrillator, administration of oxygen, and starting an intravenous (IV) line.

4.4. Audiograms

A. Audiograms are performed on many physical examinations, including those for participants in the Hearing Conservation Program (see AFST- 1800.1-003, Hearing Conservation).

B. The manufacturer’s instructions for operating the audiometer will be maintained near the hearing booth.

C. The RN will observe an individual’s tympanic membranes prior to testing; if the tympanic membrane is not visible, e.g., excessive cerumen, the audiogram will be delayed until the cerumen can be cleared.

D. Required training in accordance with the Hearing Conservation Program requirements listed in AFST-1800.1-003 (and corresponding NASA procedural requirements), will be accomplished at the time of physical examination. This training will be accomplished by the clinician or certified Council for Accreditation in Occupational Hearing Conservation (CAOHC) nurse.

E. Appropriate documentation of the individual’s training and testing will be accomplished in Cority® EHR.

4.5. Tuberculosis (TB) Skin Testing Procedures

A. Mantoux purified protein derivative (PPD) tuberculin skin testing is the method used at the Health Unit. The RN will ask the individual if he or she has ever had a significant reaction previously to the Mantoux (PPD) skin test; if so, the individual will NOT be tested.

B. Employees who have received the BCG (Bacillus Calmette Guerin) vaccine will still be tested (i.e., BCG is not a contraindication to testing).

C. The RN will administer the PPD in the standard fashion. The employee’s reaction to the Mantoux test will be read 48 to 72 hours after the injection; if the employee presents outside of this time frame, the entire process will be restarted.

D. The area of induration (palpable swelling) around the site of injection will be measured perpendicular to the long axis of the forearm;

erythema (redness) will not be measured. All reactions will be content. Armstrong distribution only. Contact the MSO regarding external distribution.

recorded in millimeters of induration, and will be recorded in the NASA electronic health record system.

4.6. General Laboratory Collection Procedures

A. There will only be one examinee in the laboratory area at any given time.

B. The examinee and the purpose of the visit will be identified by name upon entering the lab.

C. Specimen collectors will follow universal precautions for all collections.

D. Once a specimen is collected, it will be labeled, stored, and transported in accordance with the clinical laboratory vendor’s requirements.

4.7. Blood Specimen Collection (Venipuncture)

A. The RN will confirm that the individual has been fasting for twelve (12) hours, and has never had a syncopal (fainting) episode during venipuncture. If there is a history of syncope or near-syncope, the individual will be placed in a recumbent position before initiating the blood draw. Such a history will be annotated in the individual’s medical record, if not already done so.

B. Once the blood has been collected, the RN will spin the balanced tubes in the laboratory centrifuge for fifteen (15) minutes.

C. The RN will ensure that all specimens are placed in the appropriate vendor’s laboratory bag, with the laboratory slip identification facing outward, and will ensure specimens are delivered to the clinical lab vendor’s pick-up station before close-of-business that same day.

4.8. Urine Specimen Collection

A. The RN (i.e., the collector) will direct the employee to the restroom adjacent to the laboratory area and instruct him or her on the proper way to obtain a specimen in the sterile urine collection cup.

B. The collector will transfer urine to sterile screw cap container making sure top is securely fastened.

C. If a simple urine dipstick analysis is required, the collector will perform it according to the instructions for the reagent strips for urinalysis found in each box.

D. The collector will dispose of excess urine in toilet adjacent to the laboratory area, and dispose of the urine cup accordingly.

content. Armstrong distribution only. Contact the MSO regarding external distribution.

4.9. Abnormal Laboratory Values

A. When the laboratory results are received, the RN will highlight abnormal laboratory values, and will bring them to the attention of the clinician; significantly abnormal results will be brought to the clinician’s attention immediately. Abnormal urine dipstick results are to be addressed while the examinee is in the clinic.

B. The clinician is responsible for communicating the abnormal results to the examinee. This may be by phone, through face-to-face consultation (e.g., during the second part of the physical examination), by letter, or by some other means as determined by the clinician. If such communication is not immediately forthcoming, the clinician will ensure that a reasonable attempt to make such communication has been made. In the event of a failure to communicate with the examinee, the clinician will specifically document the types of attempts made, noting the dates, times, and the methods of communication attempted.

C. The clinician will document the communication with the employee in the employee’s medical record, noting the specific result(s) of concern.

Any recommendations for follow-up with the employee’s private medical doctor will be noted. The employee will be offered a copy of the laboratory results.

4.10. Fitness Center Operations

Medical Clearance: All Fitness Center participants will be cleared through the Center Health Unit Clinician. A clearance simply signed by an individual’s private physician is NOT acceptable. A Fitness Center medical clearance does NOT guarantee that an individual will not get injured or experience medical problems (e.g., myocardial infarction), while exercising. In order to obtain medical clearance, individuals will:

A. Complete a Fitness Center Clearance Questionnaire at the Health Unit.

B. The Health Unit clinician will review the applicant’s questionnaire.

Based on the responses to the Fitness Center Clearance Questionnaire the clinician will determine whether to clear the applicant. If cleared, a form AFRC 10858 will be completed. If not cleared, the applicant will be given information regarding the additional evaluation that will be required.

C. Unless otherwise noted, medical clearance is good for one year beyond the date of questionnaire, as listed on AFRC 10858, Medical Clearance Request. The clinician can require a medical clearance on a more frequent basis, depending on the specific case. Any restrictions, as warranted, will be listed.

content. Armstrong distribution only. Contact the MSO regarding external distribution.

D. Routine Staffing and Qualifications

1) For safety reasons, the Fitness Center will not be operated without supervision. During hours of operation the Fitness Center will be monitored through the video monitor system located in the Health Unit.

2) The Health Unit site supervisor will provide orientation to newcomers—and recurring instruction as needed—to individuals using the equipment in the facility. However, the site supervisor is not permitted to conduct personal fitness training or instruction.

3) The Health Unit staff, including the technical document specialist, will be certified in cardiopulmonary resuscitation/automatic external defibrillator (CPR/AED) and will maintain a current certificate to such effect from either the American Red Cross or the American Heart Association.

E. Unanticipated Closure: If the Fitness Center will not be open during its normal hours of operation, an announcement will be facilitated by Health Unit personnel via the public address system, and a public email or equivalent will be sent, indicating the closure.

F. Maintenance: See AFOP-1800.1-004, Fitness Center Operations.

4.11. Medical Information Management

A. Chart Components: For medical charts started prior to April 2012 (the implementation of Cority® EHR), the following standard format will be used:

Front Cover

Privacy Stamp/Label: Middle

Allergy Sticker: Upper Right Hand Corner

Identification Label

Last Name, First Name

Date of Birth

Section 1 Summary of Care Form (AFRC 10866) – N/A after 4/2012

(Inside Front Cover)

Immunization Record (AFRC 10867) – N/A after 4/2012

Immunization Consents (e.g., Flu Shots)

TB Skin Tests (AFRC 10857)

EKG Record

Section 2 Laboratory Reports – scanned

Section 3

Spirometry (PFT) Records – N/A after 4/2012

X-Ray Results - scanned

Chronological Record of Medical Care (SF600) – N/A after

4/2012

Section 4

Emergency Response form (AFRC 10852)

Periodic Health Evaluation (former Form 1042) - scanned

Section 5

OSHA Respirator Questionnaire - scanned

Medical Examination (AFRC 10850) - scanned

Copy of DMV Forms - scanned

FAA Forms - scanned

Chart Audit (on top)

Section 6

Information from Personal Medical Doctor - scanned

Employee Education

Blood Pressure Checks – N/A after 4/2012 Miscellaneous

Section 7

Audiometric History (AFRC 10437) - scanned

Audiograms– N/A after 4/2012

Section 8

Follow-Up Healthcare Advice form

Medical Clearance Request (AFRC 10858)

(Inside Back Cover) Incident Reports (AFRC 80227)

Copy of Green DMV Card Form

4.11.1. Table 1: Employee Health Record Chart Components before 4/2012

Front Cover

Privacy Stamp/Label: Middle

Allergy Sticker: Upper Right Hand Corner

Identification Label

Last Name, First Name Date of Birth

Section 1 EKG

Section 2

Form 1042

Medical Clearance Request (AFRC 10858) FAA signed certificate

4.11.2. Table 2: Employee Health Record Chart Components after 4/2012

A. The technical documents specialist will ensure that the Privacy Act sticker is placed on the outside cover of each medical record.

B. The RN will ask whether the individual has allergies to medications, foods or other substances, and will document all reported allergies on the red sticker on the cover of each individual’s medical chart. If content. Armstrong distribution only. Contact the MSO regarding external distribution.

there are no known allergies, that fact will also be documented on the allergy sticker.

4.12. Confidentiality of Health and Medical Information

A. All medical confidential information will be handled in accordance with 5 CFR Part 293 (Personnel Records), 5 CFR Part 297 (Privacy Provisions for Personnel Records), 5 USC 552a (b) (Conditions of Disclosure), OPM/GOVT-10 (Employee Medical File System Records, including authorized “Routine Uses” for those records), Health Insurance Portability and Accountability Act of 1996 (HIPAA, Public Law 104-191), and the Privacy Act of 1974 and subsequent amendments, as well as the guidance provided by OSHA.

B. Medical confidentiality is the responsibility of each clinic staff member, and no unauthorized person will have access to the health record. All state and federal regulations that apply to privileged information and confidentiality of records will be followed to ensure the confidentiality of the health record. Authorization for disclosure of information will be accomplished in accordance with the provisions of Section 5, in conjunction with the applicable state and federal laws (as noted in the previous section). All medical records will be kept under lock and key during non-duty hours.

4.13. Copies of Medical Records

A. The CMO (or designee) is responsible for the proper release of health and medical information. Any inadvertent or improper release of confidential medical information will be brought to the attention of the CMO by an e-mail outlining the relevant facts and circumstances of the release.

B. Copy Requests Directly from Employees: Employees are entitled to any and all of the medical information in their medical chart, though the physical chart itself remains the property of NASA. Employees will be given a copy of their own medical chart, or any part thereof, upon request at no financial charge.

C. Copies of medical records will be provided within fifteen (15) days from date of receipt of written request within the Health Unit, provided appropriate consent by the individual for release of such information has been provided.

D. Any OUTSIDE request for medical information WILL be accompanied by an authorization from the individual employee. If an employee authorization does not accompany the request, the request and a release form will be returned to the requestor with an explanation. The relevant, requested part(s) of the medical record will be photocopied and/or printed from Cority® EHR. The original medical record release content. Armstrong distribution only. Contact the MSO regarding external distribution.

form will be retained and filed in the employee's record. No payment will be accepted for requests; any payment received by the Health Unit will be returned with the medical record.

E. Any requests from an attorney or legal agency for copies of medical records will be forwarded to the Center Office of the Chief Counsel.

Further direction on how to handle the request will be provided by the Legal Office.

4.14. Disposition of Health and Medical Records

For civil servants, the Human Capital Management Branch will inform the Health Unit staff regarding retiring or separating civil servants. For the identified individuals, the technical documents specialist will transfer medical chart contents to the “Employee Medical Folder” (SF-66D). The technical documents specialist will then label the SF-66D with individual’s name, identification number and date of birth, and then send it in an appropriately labeled envelope to:

National Archives and Records Administration (Annex) 1411 Boulder Boulevard Valmeyer, IL 62295

4.15. Medication Management

NOTE

Narcotic and controlled meds are no longer maintained in the clinic.

A. Providing, Tracking and Disposal

1) For the purposes of this document, administering a medication is defined as giving a single dose to an individual employee.

Dispensing (and/or “furnishing”) a medication means transferring the medication from a stock supply to a smaller container, i.e., multiple doses to be taken over a period of time, for an individual employee. RNs may administer over-the-counter medications, but will not dispense them. In accordance with applicable policies of the California Nurse Practice Code, nurse practitioners may furnish medications. For the purposes of this document, “furnishing” includes the act of providing prophylactic travel medications for deploying aircrew, e.g., malaria chemoprophylaxis for travel.

2) Medications to be administered will be in their original container provided by the manufacturer or pharmacist, and will have the content. Armstrong distribution only. Contact the MSO regarding external distribution.

original label. That is, no medications may be repackaged and/or relabeled by the RN. Any such medication will include specific written directions for use.

3) The RN will also give the individual the appropriate information sheet for the particular medication, and will advise the employee about: (a) the name of the drug and what it is for; (b) dose and frequency; (c) precautions to follow while taking the drug, and contraindications for using the drug; (d) what to do if a dose is missed; (e) what potentially serious side effects the employee should report to the Health Unit; and (f) the mild to transitory side effects that need not be reported to the Health Unit unless they persist.

B. Tracking

1) All medications dispensed or administered from the Health Unit will be annotated on a Medication Log worksheet listing the name of the medication, the date of administration or dispensing, the amount, the dose, the lot number and the expiration date of the medication.