Thursday, December 15, 2011

Employer responsibilities for supplying contract employees

My company supplies contract employees to healthcare facilities. What are my responsibilities under the Bloodborne Pathogens standard?

OSHA considers personnel providers, who send their own employees to work at other facilities, to be employers whose employees may be exposed to hazards. Because your company maintains a continuing relationship with its employees, but another employer (your client) creates and controls the hazard, there is a shared responsibility for assuring that your employees are protected from workplace hazards. The client employer has the primary responsibility for such protection, but the "lessor employer" likewise has a responsibility under the Occupational Safety and Health Act. In the context of OSHA's standard on Bloodborne Pathogens, 29 CFR 1910.1030, your company would be required, for example, to provide the general bloodborne pathogens training outlined in the standard; ensure that employees are provided with the required vaccinations; and provide proper follow-up evaluations following an exposure incident. Your clients would be responsible, for example, for providing site-specific training and personal protective equipment, and would have the primary responsibility regarding the control of potential exposure conditions. The client, of course, may specify what qualifications are required for supplied personnel, including vaccination status. It is certainly in the interest of the lessor employer to ensure that all steps required under the standard have been taken by the client employer to ensure a safe and healthful workplace for the leased employees. Toward that end, your contracts with your clients should clearly describe the responsibilities of both parties in order to ensure that all requirements of the standard are met.

Thursday, December 1, 2011

Hepatitis B Vaccinations continued!

Any workers who have reasonably anticipated contact with blood or Other Potentially Infectious Materials (OPIM) during performance of their jobs are considered to have occupational exposure and to be at risk of being infected. Workers infected with HBV face a risk for liver ailments which can be fatal, including cirrhosis of the liver and primary liver cancer. A small percentage of adults who get hepatitis B never fully recover and remain chronically infected. In addition, infected individuals can spread the virus to others through contact with their blood and other body fluids.

An employer must develop an exposure control plan and implement use of universal precautions and control measures, such as engineering controls, work practice controls, and personal protective equipment to protect all workers with occupational exposure. In addition, employers must make hepatitis B vaccination available to these workers. Hepatitis B vaccination is recognized as an effective defense against HBV infection.

What to do if an employee declines the vaccination.

Employers must ensure that workers who decline vaccination sign a declination form. The purpose of this is to encourage greater participation in the vaccination program by stating that a worker declining the vaccination remains at risk of acquiring hepatitis B. The form also states that if a worker initially declines to receive the vaccine, but at a later date decides to accept it, the employer is required to make it available, at no cost, provided the worker is still occupationally exposed.

Thursday, November 17, 2011

Are employers required to provide an HBV vaccination?

HBV Vaccination

The standard requires employers to offer the vaccination series to all workers who have occupational exposure. Examples of workers who may have occupational exposure include, but are not limited to, healthcare workers, emergency responders, morticians, first-aid personnel, correctional officers and laundry workers in hospitals and commercial laundries that service healthcare or public safety institutions. The vaccine and vaccination must be offered at no cost to the worker and at a reasonable time and place. The hepatitis B vaccination is a non-infectious, vaccine prepared from recombinant yeast cultures, rather than human blood or plasma. There is no risk of contamination from other bloodborne pathogens nor is there any chance of developing
HBV from the vaccine.

The vaccine must be administered according to the recommendations of the U.S. Public Health Service (USPHS) current at the time the procedure takes place. To ensure immunity, it is important for individuals to complete the entire course of vaccination contained in the USPHS recommendations.

The great majority of those vaccinated will develop immunity to the hepatitis B virus. The vaccine causes no harm to those who are already immune or to those who may be HBV carriers. Although workers may desire to have their blood tested for antibodies to see if vaccination is needed, employers cannot make such screening a condition of receiving vaccination and employers are not required to provide prescreening.

Employers must ensure that all occupationally exposed workers are trained about the vaccine and vaccination, including efficacy, safety, method of administration, and the benefits of vaccination. They also must be informed that the vaccine and vaccination are offered at no cost to the worker. The vaccination must be offered after the worker is trained and within 10 days of initial assignment to a job where there is occupational exposure, unless the worker has previously received the vaccine series, antibody testing has revealed that the worker is immune, or the vaccine is contraindicated for medical reasons. The employer must obtain a written opinion from the icensed healthcare professional within 15 days of the completion of the evaluation for vaccination. This written opinion is limited to whether hepatitis B vaccination is indicated for the worker and if the worker has received the vaccination.

Friday, September 30, 2011

Are there exceptions for PPE use by healthcare workers?

One way the employer can protect workers against exposure to bloodborne pathogens, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS, is by providing and ensuring they use personal protective equipment, or PPE. Wearing appropriate PPE can significantly reduce risk, since it acts as a barrier against exposure. Employers are required to provide, clean, repair, and replace this equipment as needed, and at no cost to workers.

A worker may choose, temporarily and briefly, under rare and extraordinary circumstances, to forego use of personal protective equipment. It must be the worker’s professional judgment that using the personal protective equipment would prevent the delivery of health care or public safety services or would pose an increased hazard to the safety of the worker or coworker. When such a situation occurs, the employer is required to investigate and document the circumstances to determine if there is a way to avoid it from happening again in the future. Employers and workers should be aware that this is not a blanket exemption to the requirement to use PPE. OSHA expects that this will be an extremely rare occurrence.

Wednesday, September 7, 2011

Bloodborne Pathogens and Needlestick Prevention

Needlestick injuries and other sharps-related injuries which expose workers to bloodborne pathogens continues to be an important public health concern. Workers in many different occupations are at risk of exposure to bloodborne pathogens, including Hepatitis B, Hepatitis C, and HIV/AIDS. First aid team members, housekeeping personnel in some settings, nurses and other healthcare providers are examples of workers who may be at risk of exposure.

Bloodborne Pathogens is addressed in standards specifically for the general industry.

The Occupational Safety and Health Administration hereby promulgates a standard under section 6(b) of the Occupational Safety and Health Act of 1970 (the Act), 29 U.S.C. 655 to eliminate or minimize occupational exposure to Hepatitis B Virus (HBV), Human Immunodeficiency Virus (HIV) and other bloodborne pathogens. Based on a review of the information in the rulemaking record, OSHA has made a determination that employees face a significant health risk as the result of occupational exposure to blood and other potentially infectious materials because they may contain bloodborne pathogens, including hepatitis B virus which causes Hepatitis B, a serious liver disease, and human immunodeficiency virus, which causes Acquired Immunodeficiency Syndrome (AIDS). The Agency further concludes that this exposure can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, Hepatitis B vaccination, signs and labels, and other provisions.

Saturday, February 12, 2011

HIV Transmission in the Workplace

HIV can be detected in several fluids and tissue of a person living with HIV. It is important to understand however, that finding a small amount of HIV in a body fluid or tissue does not mean that HIV is transmitted by that body fluid or tissue. Only specific fluids (blood, semen, vaginal secretions, and breast milk) from an HIV-infected person can transmit HIV. These specific fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood-stream (from a needle or syringe) for transmission to possibly occur.

Some healthcare workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, when infected blood comes in contact with a worker's open cut or is splashed into a worker's eyes or inside their nose. There has been only one instance of patients being infected by an HIV-infected dentist.

These body fluids have been shown to contain high concentrations of HIV:

  • blood
  • semen
  • vaginal fluid
  • breast milk
  • other body fluids containing blood

The following are additional body fluids that may transmit the virus that health care workers may come into contact with:

  • fluid surrounding the brain and the spinal cord
  • fluid surrounding bone joints
  • fluid surrounding an unborn baby

Sunday, February 6, 2011

Reporting Occupational Exposure to Bloodborne Pathogens

OSHA's bloodborne pathogens standard includes provisions for medical follow-up for workers who have an exposure incident. The most obvious exposure incident is a needlestick. But any specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials is considered an exposure incident and should be reported to the employer. Exposure incidents can lead to infection from hepatitis B virus (HBV) or human immunodeficiency virus (HIV) which causes AIDS. Although few cases of AIDS are directly traceable to workplace exposure, every year about 8,700 health care workers contract hepatitis B from occupational exposures. Approximately 200 will die from this bloodborne infection. Some will become carriers, passing the infection on to others.

WHY REPORT?
Reporting an exposure incident right away permits immediate medical follow-up. Early action is crucial. Immediate intervention can forestall the development of hepatitis B or enable the affected worker to track potential HIV infection. Prompt reporting also can help the worker avoid spreading bloodborne infection to others. Further, it enables the employer to evaluate the circumstances surrounding the exposure incident to try to find ways to prevent such a situation from occurring again.
Reporting is also important because part of the follow-up includes testing the blood of the source individual to determine HBV and HIV infectivity if this is unknown and if permission for testing can be obtained. The exposed employee must be informed of the results of these tests. Employers must tell the employee what to do if an exposure incident occurs.

MEDICAL EVALUATION AND FOLLOW-UP
Employers must provide free medical evaluation and treatment to employees who experience an exposure incident. They are to refer exposed employees to a licensed health care provider who will counsel the individual about what happened and how to prevent fiuther spread of any potential infection. He or she will prescribe appropriate treatment in line with current U.S. Public Health Service recommendations. The licensed health care provider also will evaluate any reported illness to determine if the symptoms may be related to HIV or HBV development.
The first step is to test the blood of the exposed employee. Any employee who wants to participate in the medical evaluation program must agree to have blood drawn. However, the employee has the option to give the blood sample but refuse permission for HIV testing at that time. The employer must maintain the employee's blood sample for 90 days in case the employee changes his or her mind about testing--should symptoms develop that might relate to HIV or HBV infection.
The health care provider will counsel the employee based on the test results. If the source individual was HBV positive or in a high risk category, the exposed employee may be given hepatitis B immune globulin and vaccination, as necessary. If there is no information on the source individual or the test is negative, and the employee has not been vaccinated or does not have immunity based on his or her test, he or she may receive the vaccine. Further, the health care provider will discuss any other findings from the tests.
The standard requires that the employer make the hepatitis B vaccine available, at no cost to the employee, to all employees who have occupational exposure to blood and other potentially infectious materials. This requirement is in addition to post exposure testing and treatment responsibilities.

WRITTEN OPINION
In addition to counseling the employee, the health care provider will provide a written report to the employer. This report simply identifies whether hepatitis B vaccination was recommended for the exposed employee and whether or not the employee received vaccination. The health care provider also must note that the employee has been informed of the results of the evaluation and told of any medical conditions resulting from exposure to blood which require further evaluation or treatment. Any added findings must be kept confidential.

CONFIDENTIALITY
Medical records must remain confidential. They are not available to the employer. The employee must give specific written consent for anyone to see the records. Records must be maintained for the duration of employment plus 30 years in accordance with OSHA's standard on access to employee exposure and medical records.



National Safety Compliance has developed a Workplace Bloodborne Pathogens Training Program that is available for use by employers. Visit this link for more information:

OSHA Bloodborne Pathogens Safety Training

Wednesday, January 26, 2011

Bloodborne Pathogens Training Requirements

Question: Do the OSHA regulations require that the person conducting bloodborne pathogens training be a health care professional?

Response: No. The Bloodborne Pathogens Standard, 29 CFR 1910.1030, does not specify a particular job classification for qualified trainers. 29 CFR 1910.1030(g)(2)(viii) does however require that the trainer be: knowledgeable in the subject matter covered by the elements contained in the training program. . . In OSHA's bloodborne pathogens compliance directive (OSHA Instruction CPL 02-02-069), we state: possible trainers include a variety of healthcare professionals such as infection control practitioners, nurse practitioners, registered nurses, occupational health professionals, physician's assistants, and emergency medical technicians. Non-healthcare professionals, such as but not limited to, industrial hygienists, epidemiologists, or workplace trainers, may conduct the training provided they are knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace. One way, but not the only way, knowledge can be demonstrated is the fact that the person received specialized training.

National Safety Compliance has developed a blooborne pathogens training program that assists employers with OSHA compliance. For more information about this program, please click the following link: OSHA Bloodborne Pathogens Safety Training

Thursday, January 6, 2011

Medical Dental Office Bloodborne Pathogens

Question 1: Do "universal precautions" apply to the activities of medical and dental facilities (e. g., the handling of masks, goggles, gloves, lab coats or other personal protective equipment (PPE))?

Reply 1: Yes. According to the Bloodborne Pathogens Standard, "Universal precautions" is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens." OSHA Regulations 29 CFR 1910.1030(b). 29 CFR 1910.1030(d)(1) requires that universal precautions be observed to prevent contact with blood or other potentially infectious materials. This would include the handling of PPE that has become contaminated with blood or other potentially infectious materials (OPIM) in medical and/or dental facilities.

Question 2: Would it be a violation of the Bloodborne Pathogens Standard if medical or dental facilities failed to adhere to universal precautions for the handling of blood, OPIM, or items, such as laundry contaminated with blood or OPIM?

Reply 2: Yes. Medical and dental facilities failing to adhere to universal precautions would be in violation of section 29 CFR 1910.1030(d)(1) unless the facility is observing a more stringent set of guidelines. According to the Centers for Disease Control and Prevention's (CDC's) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007: "Standard precautions combine the major features of Universal Precautions and Body Substance Isolation and are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. . ."1 These include hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices. Standard precautions are more stringent than universal precautions alone and would be acceptable.

Question 3: Would potential contact of textiles, such as linen or laundry, with unknown body fluids in medical or dental settings where universal precautions are practiced trigger coverage under OSHA's Bloodborne Pathogens Standard at that medical or dental facility? Also, would the contaminated textiles require special handling under the Bloodborne Pathogens Standard?

Reply 3: Pursuant to 29 CFR 1910.1030(a), the Bloodborne Pathogens standard is applicable to all occupational exposure to blood or other potentially infectious material (OPIM), as defined in 29 CFR 1910.1030(b). The definition of OPIM includes saliva in dental procedures, among other things. Occupational exposure is defined as "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties." A determination of the duties, tasks, and scope of the employees' work must be done by the employer to assess whether employees have reasonably anticipated exposure to blood or OPIM [29 CFR 1910.1030(c)(2)]. Employers with employees who launder or otherwise handle linen contaminated with blood or OPIM (e.g., housekeeping staff in a healthcare setting; employees in a commercial laundry facility with a contract to launder contaminated linen from medical/dental settings) would be considered to have reasonably anticipated exposure and would be covered by the standard. Blood is often found on linen and laundry in medical facilities, and saliva is often found on such materials in dental offices. With respect to unknown fluids, 29 CFR 1910.1030(d)(1) provides in pertinent part: "Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials." The fact that the contaminated textiles are in a medical or dental facility where universal precautions are practiced would not preclude coverage under the Bloodborne Pathogens Standard.

With regard to the handling of contaminated laundry, 29 CFR 1910.1030(d)(4)(iv) sets forth the requirements for the handling and transport of laundry contaminated with blood or OPIM. For example, 1910.1030(d)(4)(iv)(A) and 1910.1030(d)(4)(iv)(A)(1) - 1910.1030(d)(4)(iv)(A)(3) cover the handling, containerization and transport of contaminated laundry, while sections 1910.1030(d)(4)(iv)(B) and 1910.1030(d)(4)(iv)(C) cover use of PPE while handling contaminated laundry and use of color-coded or labeled bags for transport to off-site facilities that do not use universal precautions in handling all laundry (e.g., transport to an off-site commercial laundry facility). Please refer to these sections of the standard for the specific requirements.

Question 4: Would an off-site facility (e.g., commercial laundry facility) which handles contaminated linen from healthcare settings be required to have a written exposure control plan?

Reply 4: Yes, as stated in the response to question #3, employers with employees who launder or otherwise handle linen contaminated with blood or OPIM (e.g., employees in a commercial laundry facility with a contract to launder contaminated linen from medical or dental settings) would be considered to have reasonably anticipated exposure to blood or OPIM and, thus, would be covered by the Bloodborne Pathogens Standard. Consequently, such employers are required to establish a written exposure control plan designed to eliminate or minimize employee exposure. 29 CFR 1910.1030(c)(1).

Question 5: Does an employer need to also ensure the proper laundering of contaminated linen?

Reply 5: The Bloodborne Pathogens Standard covers the handling and transport of contaminated laundry for the protection of employees; however, OSHA regulations do not have specific requirements for actual laundering procedures for assuring patient-specific infection control. OSHA's authority is limited to the protection of workers. As you noted in your inquiry, there are existing infection control guidelines set by the CDC. In the 2003 Guidelines for Environmental Infection Control in Health-Care Facilities, the CDC provides guidance for the handling, cleaning, and disinfection of contaminated laundry. The document can be found at http://www.osha.gov/pls/oshaweb/owaredirect.html?p_url=http:/www.cdc.gov/mmwr/preview/mmwrhtm/rr5210a1.htm.

Question 6: Is it permissible for employees to launder personal protective equipment like scrubs or other clothing worn next to the skin at home?

Reply 6: In your inquiry, you correctly note that it is unacceptable for contaminated PPE to be laundered at home by employees. However employees' uniforms or scrubs which are usually worn in a manner similar to street clothes are generally not intended to be PPE and are, therefore, not expected to be contaminated with blood or OPIM. These would not need to be handled in the same manner as contaminated laundry or contaminated PPE unless the uniforms or scrubs have not been properly protected and become contaminated.

Question 7: Is an employer in a dental office responsible for implementing an exposure control plan at the establishment if that employer launders the contaminated linen or PPE onsite?

Reply 7: Yes. Again, please see the response to question #3 above. Also, please be aware that dental offices would have other reasonably anticipated exposure scenarios other than the laundering of contaminated PPE that would make it necessary to develop and implement an exposure control plan. The exposure control plan should cover all job classifications and tasks in which employees have occupational exposure.

Question 8: Is that same employer responsible for following the CDC guidelines for laundering contaminated laundry?

Reply 8: The CDC guidelines are not mandatory. They are recommendations written with the intent of enhancing infection control measures in all healthcare facilities, including dental settings.

Question 9: How would OSHA regard an employer in a dental office who does not adhere to the requirements of the Bloodborne Pathogens Standard (e.g., use of universal precautions and establishment of an exposure control plan) and who does not use proper procedures for laundering contaminated laundry?

Reply 9: Again, please see the response to question #3 above. All employers having employees with occupational exposure must comply with the requirements of the Bloodborne Pathogens Standard and would be considered noncompliant for failing to do so. Please see the response to question #8 above with regard to the use of proper procedures for laundering contaminated linen.

National Safety Compliance has developed an employee training program that is specific to bloodborne pathogens. For more information about this program, please visit this link: OSHA Bloodborne Pathogens Safety Training Program