Definitions | Occupational Exposure to Bloodborne Pathogens

Definitions

§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.)

3.  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.

4.  Exposure incident: In this definition, “non-intact skin” includes skin with dermatitis, hangnails, cuts, abrasions, chafing, acne, etc.

5.  Engineering controls: 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.

6.  Needleless systems: 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.

7.  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.

8.  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.

9.  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.

10.  Sharps with engineered sharps injury protections (SESIPs): “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.

Scope and application | Occupational Exposure to Bloodborne Pathogens

Scope and application

§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.

a.     Part-time, temporary, and healthcare workers known as “per diem” employees are covered by this standard.

b.    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.

c.     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.

d.    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.

e.     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. 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.

Multi-Employer and Related Worksites | Bloodborne Pathogens

There are a number of different types of multi-employer worksites. This paragraph addresses a few typical situations but does not address all the circumstances that occur. In addition, this paragraph deals with situations in which employees are sent out to sites that are not multi-employer worksites. Where these guidelines do not address a particular question, see CPL 2-0.124, Multi-Employer Citation Policy.

Employment agencies

An employment agency refers job applicants to potential employers but does not put these workers on the payroll or otherwise establish an employment relationship with them; thus, the employment agency is not the employer of these workers. These agencies shall not be cited for violations affecting the workers they refer. The company that uses these workers, e.g., a hospital, is the employer of these workers and shall be cited for all violations affecting them.

Personnel services

Personnel services firms employ medical care staff and service employees who are assigned to work at hospitals and other healthcare facilities that contract with the firm. Typically, the employees are on the payroll of the personnel services firm, but the healthcare facility exercises day-to-day supervision over them. In these circumstances, due to the concerns expressed by the court in American Dental Association v. Martin, 984 F.2d 823, 829-30 (7th Cir. 1993) (dictum about medical personnel services) the personnel services firm should be cited for violations of the bloodborne pathogens standard only in the following categories: (1) hepatitis B vaccinations; (2) post-exposure evaluation and follow-up; (3) recordkeeping under paragraph (h) of the standard; (4) generic training; (5) violations occurring at the healthcare facility about which the personnel services firm actually knew and where the firm failed to take reasonable steps to have the host employer (the employer using the workers, e.g., a hospital) correct the violation (see FIRM multi-employer worksite guidelines); and (6) pervasive serious violations occurring at the healthcare facility about which the personnel service firm could have known with the exercise of reasonable diligence.

When the host employer exercises day-to-day supervision over the personnel service workers, they are the employees of the host employer, as well as of the personnel service, and thus the host employer must comply with all provisions of the standard with respect to these workers. With respect to Hepatitis B vaccination, post-exposure evaluation and follow-up, recordkeeping, and generic training, the host employer’s obligation is to take reasonable measures to assure that the personnel service firm has complied with these provisions.

Home health services

The American Dental Association v. Martin decision upheld the bloodborne pathogens standard but restricted its application in the home health services industry. These are companies whose employees provide home health services in private homes. The court held that OSHA had not adequately considered feasibility problems for such employers, where employees work at sites that the employer does not control. As a result, OSHA may not cite those employers for site-dependent provisions of the standard when the hazard is site-specific.

In implementing this decision, OSHA determined that the employer will not be held responsible for the following site-specific violations: housekeeping requirements, such as the maintenance of a clean and sanitary worksite and the handling and disposal of regulated waste; ensuring the use of personal protective equipment; and ensuring that specific work practices are followed (e.g., handwashing with running water) and ensuring the use of engineering controls.

The employer will be held responsible for all non-site-specific requirements of the standard, including the non-site specific requirements of the exposure control plan, hepatitis B vaccinations, post exposure evaluation and follow-up, recordkeeping, and the generic training requirements. OSHA will also cite employers for failure to supply appropriate personal protective equipment to employees.

Physicians and healthcare professionals who have established an independent practice

In applying the provisions of the standard in situations involving physicians, the status of the physician is important. Physicians may be employers or employees. Physicians who are unincorporated sole proprietors or partners in a bona fide partnership are employers for purposes of the OSH Act and may be cited if they employ at least one employee (such as a technician or secretary). Such physician-employers may be cited if they create or control bloodborne pathogens hazards that expose employees at hospitals or other sites where they have staff privileges in accordance with the multi-employer worksite guidelines of CPL 2-0.124, Multi-Employer Citation Policy. Because physicians in these situations are not themselves employees, citations may not be based on the exposure of such physicians to the hazards of bloodborne diseases.

Physicians may be employed by a hospital or other healthcare facility or may be members of a professional corporation and conduct some of their activities at host employer sites where they have staff privileges. In general, professional corporations are the employers of their physician-members and must comply with the hepatitis B vaccination, post-exposure-evaluation and follow up, recordkeeping, and generic training provisions with respect to these physicians when they work at host employer sites. The host employer is not responsible for these provisions with respect to physicians with staff privileges, but in appropriate circumstances, may be cited under other provisions of the standard in accordance with the multi-employer work-site guidelines of CPL 2-0.124, Multi-Employer Citation Policy. The professional corporation may also be cited under other provisions of the standard for the exposure of its physicians and other workers at a host employer site in accordance with the multi-employer worksite guidelines of CPL 2-0.124, Multi-Employer Citation Policy.

Independent contractors

These are companies that provide a service, such as radiology or housekeeping, to host employers. They provide supervisory personnel, as well as rank-and-file workers, to carry out the service. These companies and the host employers are responsible for complying with all provisions of the standard in accordance with the multi-employer worksite guidelines of CPL 2-0.124, Multi-Employer Citation Policy.