Friday, October 26, 2012

Acceptable time lapse for "annual training."

January 24, 2007

Mr. D. C. Skinner
Employer Management Technical Policy Consultant
Ohio Bureau of Workers' Compensation
One Government Center, Suite 1236
Toledo, Ohio 43604

Dear Mr. Skinner:

Thank you for your letter to the Occupational Safety and Health Administration's (OSHA's) Directorate of Enforcement Programs (DEP). This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. You requested clarification on OSHA's interpretation of acceptable time lapse for "annual" training.

Scenario: Various OSHA standards address frequency of employee training. Some standards are very explicit on frequency, stating "no later than 12 months from the date of the previous training," while others simply state that training must be performed "at least annually."

Question: Could you please clarify OSHA's interpretation of training requirements and what is expected when training must be conducted "at least annually"?

Reply: You are correct in stating that the language may vary in certain OSHA standards. However, wherever OSHA standards require that employee training be conducted "at least annually," OSHA interprets that to mean that employees must be provided re-training at least once every 12 months (i.e., within a time period not exceeding 365 days.) This annual training need not be performed on the exact anniversary date of the preceding training, but should be provided on a date reasonably close to the anniversary date taking into consideration the company's and the employees' convenience in scheduling. If the annual training cannot be completed by the anniversary date, the employer should maintain a record indicating why the training has been delayed and when the training will be provided.

Please keep in mind that the term "at least annually" is generally regarded as indicating that circumstances which warrant more frequent training may occur. It is extremely important that employees are trained to protect themselves from all known workplace hazards, including new hazards which may result from changes in workplace practices, procedures, or tasks. For example, OSHA's bloodborne pathogens standard at 29 CFR 1910.1030(g)(2)(v), provides for "additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupation exposure." More frequent training may also be required when employee performance suggests that the prior training was incomplete or not fully understood.

Thursday, October 18, 2012

Applicability of Bloodborne Pathogens Standard to HCV (Hepatitis C Vaccination)

March 25, 1999

Dear Mr. Thorsland:

We received your letter dated December 21, 1998, addressed to the Occupational Safety and Health Administration's (OSHA's) [Office of Health Enforcement (OHE)], regarding the inclusion of the Hepatitis C Virus (HCV) under 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens. Thank you for your inquiry. Your concern was whether HCV is included as a specific bloodborne pathogen included in (f)(3), which addresses Hepatitis B vaccination (HBV) and post-exposure evaluation and follow-up procedures. Your questions are restated below, followed by OSHA's response.

  1. (Can) 'HCV' just be substituted for 'HBV' and 'HIV' in the wording of the citations (section (f)(3))?
  2. Could you please forward to us the correct policy regarding citing HCV violations under 29 CFR 1910.1030?
A number of resources are available to you that outline the definitions of bloodborne pathogens which are included in 29 CFR 1910.1030. The preamble published in the Federal Register, Vol. 58, No. 235, December 6, 1991, defines bloodborne pathogens to include "HBV, HIV, and other pathogens including hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeld-Jakob Disease, Human T-lymphotrophic virus Type I, and Viral Hemorrhagic Fever." The preamble is quoted as stating, "HBV and HIV are given as examples because they are the viruses of greatest interest and present the greatest risk. Adding additional examples to the definition would not improve the definition."

OSHA Instruction [CPL 2-2.69, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens], states "while HBV and HIV are specifically identified in the standard, the term includes any pathogenic microorganism that is present in human blood and can infect and cause disease in persons who are exposed to blood containing the pathogen. Other examples include hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeld-Jakob Disease, Human T-lymphotrophic Virus Type 1, and viral hemorrhagic fever."

Additionally, the preamble to the standard discusses the health effects of hepatitis viruses and covers the transmission and infectious nature of the hepatitis viruses, specifically hepatitis C. It addresses the fact that "parenterally transmitted non-A, non-B hepatitis is caused by at least one bloodborne virus, designated hepatitis C virus (HCV)." This is an example of and further indication that, in addition to HBV and HIV, "other bloodborne diseases, hepatitis C, delta hepatitis, syphilis, and malaria" are included in the discussion of this standard and its potential hazard in the workplace. We hope that we have given you several examples of the inclusion of HCV, as an example of a bloodborne pathogen in the standard.

With regards to your second inquiry, OSHA Instruction [CPL 2-2.69] outlines inspection and citation guidelines. Generally,citations shall be issued if work practice controls, engineering controls and personal protective equipment are not used to eliminate or minimize employee exposure to bloodborne pathogens. For post-exposure evaluation and follow-up as required in paragraph (f)(3), a citation shall be issued if a compliance officer determines that an employer did not make immediately available a confidential medical evaluation and follow-up after an exposure incident. At sites where an exposure incident has occurred, it should be determined if the procedures were properly followed through interviews, incident report review, and, if necessary, medical record reviews. Furthermore, if a compliance officer believes that an employer is not properly following accepted post-exposure procedures, or needs specific information about current accepted procedures, the Regional bloodborne pathogens coordinator should be contacted. These details and many other concerning compliance to this standard are available for your perusal in either the original standard, 29 CFR 1910.1030, and/or OSHA Instruction [CPL 2-2.69].

However, not all provisions of the bloodborne pathogens standard apply to hepatitis C. Section 1910.1030(f)(3)(ii)(A)-(C) and (f)(3)(iii) only apply to testing for HBV and HIV after an exposure incident. Section 1910.1030(e) only applies to HIV and HBV research laboratories and production facilities. Section 1910.1030(f)(1)(i),(2),(4)(i) and (5)(i) only apply to HBV (HBV vaccination, information provided to healthcare professional, and healthcare professional's written opinion). Section 1910.1030(g)(1)(ii) only applies to signs in HIV and HBV research laboratories and production facilities. Section 1910.1030(g)(2)(vii)(I) only applies to training about the HBV vaccine and (g)(2)(ix) only applies to training in HIV and HBV laboratories and production facilities. Section 1910.1030(h)(ii)(B) only applies to keeping records of an employee's HBV vaccination status.

Tuesday, October 16, 2012

29 CFR 1910.1030 Clarification of the Standard

Clarification of the Standard on Occupational Exposure to Bloodborne Pathogens, 29 CFR 1910.1030. The guidance that follows relates to specific provisions of 29 CFR 1910.1030 and is provided to assist compliance officers in conducting inspections where the standard may be applicable:

  1. Scope and Application - 29 CFR 1910.1030(a). This paragraph defines the range of employees covered by the standard.

    1. Since there is no population that is risk free for HIV, HBV or other bloodborne disease infection, any employee who has occupational exposure to blood or other potentially infectious material will be included within the scope of this standard.
    2. Although a list is included below of a number of job classifications that may be associated with tasks that have occupational exposure to blood and other potentially infectious materials, the scope of this standard is not limited to employees in these jobs. The hazard of exposure to infectious materials affects employees in many types of employment and is not restricted to the healthcare industry. At the same time, employees in the following jobs are not automatically covered unless they have the potential for occupational exposure:

      Physicians, physician's assistants, nurses, nurse practitioners, and other healthcare employees in clinics and physicians' offices; employees of clinical and diagnostic laboratories; housekeepers in healthcare and other facilities; personnel in hospital laundries or commercial laundries that service healthcare or public safety institutions; tissue bank personnel; employees in blood banks and plasma centers who collect, transport, and test blood; freestanding clinic employees (e.g., hemodialysis clinics, urgent care clinics, health maintenance organization (HMO) clinics, and family planning clinics); employees in clinics in industrial, educational, and correctional facilities (e.g., those who collect blood, and clean and dress wounds); employees designated to provide emergency first aid; dentists, dental hygienists, dental assistants and dental laboratory technicians; staff of institutions for the developmentally disabled; hospice employees; home healthcare workers; staff of nursing homes and long-term care facilities; employees of funeral homes and mortuaries; HIV and HBV research laboratory and production facility workers; employees handling regulated waste; custodial workers required to clean up contaminated sharps or spills of blood or OPIM; medical equipment service and repair personnel; emergency medical technicians, paramedics, and other emergency medical service providers; fire fighters, law enforcement personnel, and correctional officers (employees in the private sector, or the Federal Government, or a state or local government in a state that has an OSHA-approved state plan); maintenance workers, such as plumbers, in healthcare facilities and employees of substance abuse clinics.
    3. INSPECTION GUIDELINES. The scope paragraph of this standard states that it "applies to all occupational exposure to blood or other potentially infectious materials as defined by paragraph (b)." The compliance officer must take careful note of the definition of "occupational exposure" in paragraph (b) in determining if an employee is covered by this standard.

      1. Part-time, temporary, and healthcare workers known as "per diem" employees are covered by this standard.
      2. OSHA jurisdiction extends only to employees in the workplace. It does not extend to students if they are not also considered employees; to state, county, or municipal employees; to health care professionals who are sole practitioners or partners, or to the self-employed. However, the 26 OSHA-approved state plans must protect state and local government workers under an "at least as effective" state standard.
      3. If an employee is trained in first aid and identified by the employer as responsible for rendering medical assistance as part of his/her job duties, that employee is covered by the standard. See the citation policy for paragraph (f)(2) of the standard below regarding designated first aid providers, who administer first aid as a collateral duty to their routine work assignments. An employee who routinely provides first aid to fellow employees with the knowledge of the employer may also fall, de facto, under this designation even if the employer has not officially designated this employee as a first aid provider.
      4. Exposure to bloodborne pathogens in shipyard operations is covered under 29 CFR 1915.1030, which states that its requirements are identical to those in 29 CFR 1910.1030.
      5. Other Industries: The bloodborne pathogens standard does not apply to the construction, agriculture, marine terminal and longshoring industries. OSHA has not, however, stated that these industries are free from the hazards of bloodborne pathogens. For industries not covered by the bloodborne pathogens standard, Section 5(a)(1) of the OSH Act provides that "each employer shall furnish to each of his employees employment and a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." The General Duty Clause should not be used to cite for violations of the bloodborne pathogens rule, but may be used to cite for failure to provide a workplace free from exposure to bloodborne pathogens. Section 5(a)(1) citations must meet the requirements outlined in the FIRM, OSHA Instruction CPL 2.103, Chapter III. Failure to implement all or any part of 29 CFR 1910.1030 should not be, in itself, the basis for a citation. Accordingly, 29 CFR 1910.1030 should not be specifically referenced in a citation.
  2. Definitions - 29 CFR 1910.1030(b). The following provides further clarifications of some definitions found in this paragraph:

    1. "Blood": The term "human blood components" includes plasma, platelets, and serosanguineous fluids (e.g., exudates from wounds). Also included are medications derived from blood, such as immune globulins, albumin, and factors 8 and 9.
    2. "Bloodborne Pathogens": While HBV and HIV are specifically identified in the standard, the term includes any pathogenic microorganism that is present in human blood or OPIM and can infect and cause disease in persons who are exposed to blood containing the pathogen. Pathogenic microorganisms can also cause diseases such as hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, diseases associated with HTLV-II, and viral hemorrhagic fever.

      NOTE: According to the Centers for Disease Control and Prevention (CDC), hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States. (MMWR: Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, October 16, 1998/Vol.47/No. RR-19.)

      HCV is a viral infection of the liver that is transmitted primarily by exposure to blood. Currently there is no vaccine effective against HCV. See discussion of paragraph (f)(3) below.
    3. "Exposure Incident": In this definition, "non-intact skin" includes skin with dermatitis, hangnails, cuts, abrasions, chafing, acne, etc
    4. "Engineering controls" means controls that isolate or remove the bloodborne pathogens hazard from the workplace. Examples include safer medical devices, such as sharps with engineered sharp injury protection (SESIPs) and needleless systems. These two terms were further defined in the revision to 1910.1030 mandated by the Needlestick Safety and Prevention Act.
    5. "Needleless Systems" means a device that does not use needles for: (1) the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) the administration of medication or fluids; or (3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps. "Needleless Systems" provide an alternative to needles for the specified procedures, thereby reducing the risk of percutaneous injury involving contaminated sharps. Examples of needleless systems include, but are not limited to, intravenous medication delivery systems that administer medication or fluids through a catheter port or connector site using a blunt cannula or other non-needle connection, and jet injection systems that deliver subcutaneous or intramuscular injections of liquid medication through the skin without use of a needle.
    6. "Occupational Exposure": The term "reasonably anticipated contact" includes the potential for contact as well as actual contact with blood or OPIM. Lack of history of blood exposures among designated first aid personnel of a particular manufacturing site, for instance, does not preclude coverage. "Reasonably anticipated contact" includes, among others, contact with blood or OPIM (including regulated waste) as well as incidents of needlesticks. For example, a compliance officer may document incidents in which an employee observes a contaminated needle on a bed or contacts other regulated waste in order to substantiate "occupational exposure."

      NOTE: This definition does not cover "Good Samaritan" acts (i.e. voluntarily aiding someone in one's place of employment) that result in exposure to blood or other potentially infectious materials from voluntarily assisting a fellow employee, although OSHA encourages employers to offer follow-up procedures to these employees in such cases.
    7. "Other Potentially Infectious Materials" (OPIM): Coverage under this definition also extends to blood and tissues of experimental animals that are infected with HIV or HBV.
    8. "Parenteral": This definition includes human bites that break the skin, which are most likely to occur in violent situations such as may be encountered by prison and law enforcement personnel and in emergency rooms or psychiatric wards.
    9. "Sharps with Engineered Sharps Injury Protections (SESIPs)" are defined as "a nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident." This term encompasses a broad array of devices that make injury involving a contaminated sharp less likely. They include, but are not limited to: syringes with guards or sliding sheaths that shield the attached needle after use; needles that retract into a syringe after use; shielded or retracting catheters used to access the bloodstream for intravenous administration of medication or fluids; intravenous medication delivery systems that administer medication or fluids through a catheter port or connector site using a needle that is housed in a protective covering, blunt suture needles; and plastic (instead of glass) capillary tubes.

    For other training information regarding Bloodborne Pathogens or any other OSHA topic, please contact National Safety Compliance, Inc.