Exposure control plan | Occupational Exposure to Bloodborne Pathogens

§1910.1030(c)

This paragraph requires the employer to identify those tasks and procedures in which occupational exposure may occur and to identify the positions whose duties include those tasks and procedures identified as having occupational exposure. The exposure control plan required by paragraph (c)(1) is a key provision of the standard because it requires the employer to identify the individuals who will receive the training, protective equipment, vaccination, and other protections of the standard.

1.  Inspection and citation guidelines. The Compliance Officer should review the facility’s written exposure control plan. While the plan may be part of a larger document, such as one addressing all health and safety hazards in the workplace, in order for the plan to be accessible to employees, it must be a cohesive entity by itself or there must be a guiding document which states the overall policy goals and references the elements of existing separate policies that comprise the plan.

The Compliance Officer should determine whether the plan is reviewed annually and updated to reflect significant modifications in tasks or procedures which may result in occupational exposure as required in paragraph (c)(1)(iv).

The location of the plan may be adapted to the circumstances of a particular workplace, provided that the employee can access a copy at the workplace, during the workshift (e.g., if the plan is maintained solely on computer, employees must be trained to operate the computer). In accordance with 29 CFR 1910.1020, a hard copy of the exposure control plan must be made available to the employee within 15 working days of the employee’s request.

If a facility is lacking an exposure control plan and the other requirements of the standard have not been implemented, the other relevant paragraphs of the standard should be cited in addition to paragraph (c). These should normally be classified as serious violations.

2.  Paragraphs (c)(1)(ii)(A) and (c)(2)(i). The exposure determination requires employers to identify and document:

a.    Those job classifications in which all employees have occupational exposure, and/or

b.    Those job classifications in which some employees have occupational exposure.

1.     In the latter case, the specific tasks and procedures, or groups of closely related tasks and procedures, which are associated with occupational exposure must be delineated. For example, only some of the employees in a hospital laundry room might be assigned the task of handling contaminated laundry.

2.     The tasks and procedures that are grouped must be related; i.e., they must share a common activity such as “vascular access procedures,” “handling of contaminated sharps,” or “handling of deceased persons,” etc.

Note

If a job classification, task, or procedure involving occupational exposure is omitted from the list, but all employees in the job or performing the task or procedure have been included in all other aspects of the plan (e.g., vaccinations, training, etc.), it is to be considered an other-than-serious violation.

c.    The exposure determination must have been made without taking into consideration the use of personal protective clothing or equipment.

3.  Paragraph (c)(1)(ii)(B). While the primary purpose of the exposure control plan is to identify those employees who have occupational exposure and to commit the employer to a timetable for implementation of the standard’s requirements, paragraphs (d)-(h) of the standard must also be addressed in a manner appropriate to the circumstances of the particular workplace. An annotated copy of the final standard may be adequate for small facilities. Larger facilities could develop a broad facility-wide program incorporating provisions from the standard that apply to their establishments.

4.  Paragraph (c)(1)(ii)(C). The exposure control plan must include the procedure for evaluating the circumstances surrounding exposure incidents, in accordance with paragraph (f)(3)(i).

Citation guidelines: If the employer failed to include procedures for the documentation of exposure incidents in the exposure control plan, a citation for paragraph (c)(1)(ii)(C), should be issued. If procedures are included in the plan but not implemented, then paragraph (f)(3)(i) should be cited.

5.  Paragraph (c)(1)(iv) requires the employer to review and update the exposure control plan at least annually (every 12 months) and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure. As stated in the preamble to the standard, the review and update must reflect innovations in procedure and technological developments that eliminate or reduce exposure to bloodborne pathogens. [56 Fed. Reg. 64109-10 (1991).] This includes, but is not limited to, newly available medical devices designed to reduce the risk of percutaneous exposure to bloodborne pathogens.

A periodic review ensures that the exposure control plan remains current with the latest information and scientific knowledge pertaining to bloodborne pathogens. A review of the sharps log required in paragraph (h)(5) can identify problem areas and/or ineffective devices which may need replacement. The exposure control plan must document consideration and implementation of appropriate commercially available and effective engineering controls designed to eliminate or minimize exposure. The Exposure Control Plan must also include the procedure for evaluation of circumstances surrounding exposure incidents. See discussion of paragraph (f)(3)(i).

Note

While the exact number of injuries sustained annually in the United States is unknown, current estimates vary between 590,000 and 800,000 injuries annually. The implementation of effective engineering controls can reduce needlesticks and other sharps injuries. Effective engineering controls include safer medical devices used to prevent percutaneous injuries before, during, or after use through safer design features. When the Final Rule was published in December 1991, the variety of engineering controls was limited although some were available. At that time adequate data and information on effective engineering controls and their effectiveness were not available. The preamble to the Final Rule in 1991 stated that “with regard to percutaneous incidents, such as needlestick injuries, evidence indicated that most injuries were preventable … 75 percent of all exposure incidents are caused by disposable syringes … and could be prevented by using syringes which incorporate resheathing or retracting designs.” [56 Fed. Reg./64057(1991)] Since publication of the standard, there has been a substantial increase in the number and assortment of effective engineering controls available to employers. There is now a large body of research and data available to OSHA and to the public concerning the effectiveness of these engineering controls.

Citation guidelines: The employer must review and update the plan, as necessary, to reflect changes in technology, such as the use of effective engineering controls, that can eliminate or minimize exposures. If the employer did not review and update its exposure control plan at least annually, paragraph (c)(1)(iv) should be cited. See Appendix D for a Sample Exposure Control Program.

6.  Paragraph (c)(1)(v) requires the employer to solicit input from non-managerial employees responsible for direct patient care in the identification, selection and evaluation of effective engineering and work practice controls and document the solicitation in the Exposure Control Plan. The employer must solicit employee input in a manner appropriate to the circumstances in the workplace. Methods for soliciting employee input may include joint labor-management safety committees; involvement in informal problem-solving groups; participation in safety meetings and audits, employee surveys, worksite inspections, or exposure incident investigations; using a suggestion box or other effective methods for obtaining written employee comments; and participation in the evaluation of devices through pilot testing.

The opportunities for employee input shall be effectively communicated to employees. Input from employees covered by a collective bargaining agreement may also be requested through their bargaining agent. Employers are not required to request input from each and every exposed employee; however, the employees selected must represent the range of exposure situations encountered in the workplace (e.g., emergency department, pediatrics, nuclear medicine). The employer must document the process by which the input was requested and identify the employees or the positions of those employees who were involved.

Inspection guidelines: Compliance Officers should determine how the devices used in the facility were selected and review the employers’ documentation of their employees’ input. Many departments require different features in a safer device and have different concerns for both employee and patient safety. Employees in various departments and situations should be interviewed to determine the extent to which the employer solicited employee input. The fact that some employees have not provided input does not automatically mean the employer has not solicited input, but should prompt the compliance officer to thoroughly investigate whether input was solicited.

Citation guidelines: This section should only be cited if input was not solicited from non-managerial employees involved in administering treatment or performing any procedure in the presence of an individual receiving care. Any employee who, for example, collects blood from patients in a nursing home; administers flu vaccinations in a factory employee health unit, or collects blood from other employees for research purposes would be performing “patient care.” Laboratory workers, on the other hand, who do not have patient contact, would not be included in this provision.